Martin Luke Sanford, D.C.
Individual provider Active NPI Chiropractor · Portola, CA
NPI 1386776367 · NPPES record last updated Jan 21, 2011
Key facts
- NPI
- 1386776367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 31697 (CA)
- Practice address
- 15 Commercial St
Portola, CA 96122-9617 - Phone
- (530) 832-4442
- NPI assigned
- Mar 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
15 Commercial St
Portola, CA 96122-9617
Phone (530) 832-4442
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110407000789 | CA | Practitioner - Chiropractic | 4183652902 | Practice locations: Portola, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31697 | CA | MD | Chiropractor |
| B01037 | NV | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | B01037 | NV | |
| Chiropractor | 111N00000X | 31697 | CA | Yes |
Addresses
Primary practice location
15 Commercial St
Portola, CA 96122-9617
Mailing address
15 Commercial St
Portola, CA 96122-9617
Phone (530) 832-4442
Other providers in Portola, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.