1518059443 NPI number — MCDERMOTT CHIROPRACTIC CENTRE LTD

Table of content: (NPI 1518059443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518059443 NPI number — MCDERMOTT CHIROPRACTIC CENTRE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCDERMOTT CHIROPRACTIC CENTRE LTD
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:
1518059443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 CRABAPPLE COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21015-6032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-569-1099
Provider Business Mailing Address Fax Number:
410-642-3552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 S UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVRE DE GRACE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21078-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-939-1111
Provider Business Practice Location Address Fax Number:
410-642-3552
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDERMOTT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-569-1099

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1540 , 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: 104646 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400163 . This is a "UNHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5921641 . This is a "APPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258998 . This is a "AMOP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 365452400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00046203 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31787 . This is a "COVE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53490401 . This is a "BSMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2020433 . This is a "AHMO" identifier . This identifiers is of the category "OTHER".




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