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MARVIN ICBAN BAUTISTA D.C.

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1215012778

Individual Registrant:
 MARVIN ICBAN BAUTISTA D.C.
Gender: M
Sole Proprietor

Location and contact information for practice:
931 SAN BRUNO AVE W RM 7  SAN BRUNO, CA 94066-3435 US
Tel: 650-225-0500  Fax: 650-225-0510

Contact information for business:
130 YOLO CT  SAN BRUNO, CA 94066-2555 US
Tel: 650-892-3669  Fax: 650-225-0510

Registration Information:
NPI: 1215012778
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
CADC28034

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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