MEDICARE: DR. RUSSELL MARAMAG DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	32264	CA

General Provider Information

NPI Number	:	1710244538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL MARAMAG DC

Provider Business Mailing Address
First Line	:	2910 STEVENS CREEK BLVD STE 209
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2015
Country	:	US
Telephone Number	:	408-261-0772
Fax Number	:	408-261-0766

Provider Business Practice Location Address
First Line	:	2910 STEVENS CREEK BLVD STE 209
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2015
Country	:	US
Telephone Number	:	408-261-0772
Fax Number	:	408-261-0766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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