1134292873 NPI number — TOTAL WELLNESS CHIROPRACTIC CENTER OF BOWIE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134292873 NPI number — TOTAL WELLNESS CHIROPRACTIC CENTER OF BOWIE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL WELLNESS CHIROPRACTIC CENTER OF BOWIE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134292873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 LAUREL BOWIE RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20715-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-352-3454
Provider Business Mailing Address Fax Number:
301-352-0893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 LAUREL BOWIE RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-352-3454
Provider Business Practice Location Address Fax Number:
301-352-0893
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAPPES
Authorized Official First Name:
TINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ESTABLISHMENT EXECUTIVE
Authorized Official Telephone Number:
301-352-3454

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LU06T0 . This is a "BCBS-MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F015 . This is a "BCBS-DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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