Martin Paul Fiedler, DC
Individual provider Active NPI Chiropractor · Lower Lake, CA
NPI 1083777007 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083777007
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC015919 (CA)
- Practice address
- 9667 Hwy 29
Ste 101
Lower Lake, CA 95457 - Phone
- (707) 994-6940
- Fax
- (707) 994-6941
- NPI assigned
- Dec 19, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC015919 | CA | MD | Chiropractor |
| 15919 | CA | MD | Dental Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC015919 | CA | Yes |
Addresses
Primary practice location
9667 Hwy 29
Ste 101
Lower Lake, CA 95457
Mailing address
PO Box 298
9667 Hwy 29 Ste 101
Lower Lake, CA 95457
Phone (707) 994-6940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GDC000500 | Medicaid | CA |
Other providers in Lower Lake, CA
- Krissie Deleon
- Kristina Suzette Ervin-Funk
- Evergreen Team Holdings LLC - Supporting Bright Futures Dba
- Melissa Farrell
- Fiedler Chiropractic Inc
- Ralph A Fiedler
- Richard Hoffman
- Konocti Unified School District
- Lake County Community Action Agency
- Lake County Community Action Agency
All providers in Lower Lake, CA · Chiropractor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.