1558486936 NPI number — TABER CHIROPRACTIC, P.C.

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 1558486936 NPI number — TABER CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TABER 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:
1558486936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14300 GALLANT FOX LANE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20715-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-352-4500
Provider Business Mailing Address Fax Number:
301-352-6510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14300 GALLANT FOX LANE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-352-4500
Provider Business Practice Location Address Fax Number:
301-352-6510
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TABER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
LENZEN
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
301-352-4500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , 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: LR25TA . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S241 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: LR25TA . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S241 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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