1457504318 NPI number — PERRY HALL CHIROPRACTIC & PHYSICAL THERAPY 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 1457504318 NPI number — PERRY HALL CHIROPRACTIC & PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRY HALL CHIROPRACTIC & PHYSICAL THERAPY 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:
1457504318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8817 BELAIR RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-256-9650
Provider Business Mailing Address Fax Number:
410-256-3339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8817 BELAIR RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-256-9650
Provider Business Practice Location Address Fax Number:
410-256-3339
Provider Enumeration Date:
10/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TRAVAGLINE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
410-256-9650

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: N5230000 . This is a "GHMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F6HFPE . This is a "CARE FIRST BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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