1205987682 NPI number — DELMARVA CHIROPRACTIC, P.C.

Table of content: (NPI 1205987682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205987682 NPI number — DELMARVA CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMARVA CHIROPRACTIC, P.C.
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:
1205987682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 BELMONT AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-4543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-219-5155
Provider Business Mailing Address Fax Number:
410-219-3579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 BELMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-219-5155
Provider Business Practice Location Address Fax Number:
410-219-3579
Provider Enumeration Date:
01/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAWBER
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-219-5155

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  S03401 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194894295 . This is a "DR BROWN'S NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1366555302 . This is a "DR LANE'S NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com