Provider Demographics
NPI:1932191871
Name:LAUDIG, MARTY JO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:JO
Last Name:LAUDIG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1623
Mailing Address - Country:US
Mailing Address - Phone:310-530-1659
Mailing Address - Fax:310-872-5531
Practice Address - Street 1:2170 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1623
Practice Address - Country:US
Practice Address - Phone:310-530-1659
Practice Address - Fax:310-872-5531
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC028800Medicare PIN
CAGL979AMedicare PIN