Provider Demographics
NPI:1215202395
Name:MARTIN BORGE D C, P C
Entity Type:Organization
Organization Name:MARTIN BORGE D C, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-492-9355
Mailing Address - Street 1:880 LAS GALLINAS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3437
Mailing Address - Country:US
Mailing Address - Phone:415-663-9333
Mailing Address - Fax:415-663-9350
Practice Address - Street 1:880 LAS GALLINAS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3437
Practice Address - Country:US
Practice Address - Phone:415-492-9355
Practice Address - Fax:415-492-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0162730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty