Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Marvin Icban Bautista, DC

Individual provider Chiropractor · NPI 1215012778

Marvin Icban Bautista, DC is a Chiropractic in San Bruno, California. Graduated from Palmer College Chiropractic - West Sunnyvale in 2001, 25 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
25
Trained at
Palmer College Chiropractic - West Sunnyvale
Licensed in
CA
In the registry since
2006
What do these letters mean?
DC — Doctor of Chiropractic
A licensed chiropractor.

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Practice location Address checks out

931 San Bruno Ave W Rm 7
San Bruno, CA 94066-3435
Phone: (650) 225-0500
Fax: (650) 225-0510
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Chiropractor (primary) Taxonomy 111N00000X · Licence DC28034 (CA)

Record details

NPI number1215012778
Entity typeIndividual (Type 1)
GenderMale
Credentials DC
Sole proprietorYes
NPI enumeratedOctober 25, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCHIROPRACTIC
Medical schoolPALMER COLLEGE CHIROPRACTIC - WEST SUNNYVALE
Graduated 2001 (25 years in practice)
Accepts Medicare assignment Not indicated

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