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MARVIN ICBAN BAUTISTA D.C.
>> Chiropractor >> Chiropractic ProvidersRegistrant NPI Number: 1215012778
Individual Registrant: MARVIN ICBAN BAUTISTA D.C.
Gender: M
Sole Proprietor
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
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
Tel: 650-892-3669 Fax: 650-225-0510
Registration Information:
NPI: 1215012778
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 111N00000X | Chiropractic Providers Chiropractor | CA | DC28034 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
