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

Table of content: (NPI 1134292873)

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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