MEDICARE: JUAN CARLOS MARIN D.C.

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	111N00000X	Chiropractor	038012440	IL
2	111N00000X	Chiropractor	33745	CA

General Provider Information

NPI Number	:	1972937712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS MARIN D.C.

Provider Business Mailing Address
First Line	:	2221 KING CT UNIT 31
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-5179
Country	:	US
Telephone Number	:	563-542-4596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 PHILLIPS LN STE 300
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2552
Country	:	US
Telephone Number	:	805-543-8688
Fax Number	:	805-543-8732

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

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	09/20/2022

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