1992986772 NPI number — O'BRIEN FAMILY CHIROPRACTIC CENTER

Table of content: (NPI 1992986772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992986772 NPI number — O'BRIEN FAMILY CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'BRIEN FAMILY CHIROPRACTIC CENTER
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:
O'BRIEN CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1992986772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1912 LINCOLN DR
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-4119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-268-8496
Provider Business Mailing Address Fax Number:
410-268-4856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1912 LINCOLN DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-268-8496
Provider Business Practice Location Address Fax Number:
410-268-4856
Provider Enumeration Date:
11/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'BRIEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-268-8496

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  01472 , 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: 937M . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 01472PT . This is a "STATE LISENCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 990A . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2135935 . This is a "ALLIANCE MAMSI MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W32600001 . This is a "CAREFIRST NCA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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