Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC015998 | CA |
NPI | 1104857754 |
---|---|
Provider Name | Michael Joseph Martello |
First Address | Pacific Grove, CA 93950-4309 |
Second Address | Pacific Grove, CA 93950-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |