Provider Demographics
NPI:1083777007
Name:FIEDLER, MARTIN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PAUL
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:9667 HWY 29 STE 101
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457
Mailing Address - Country:US
Mailing Address - Phone:707-994-6940
Mailing Address - Fax:707-994-6941
Practice Address - Street 1:9667 HWY 29
Practice Address - Street 2:STE 101
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457
Practice Address - Country:US
Practice Address - Phone:707-994-6940
Practice Address - Fax:707-994-6941
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC015919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGDC000500Medicaid
CAGDC000500Medicaid
CAT05955Medicare UPIN