1669515656 NPI number — BALLENGER CREEK CHIROPRACTIC INC

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 1669515656 NPI number — BALLENGER CREEK CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALLENGER CREEK CHIROPRACTIC INC
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:
1669515656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 SOLAREX CT
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21703-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-620-1008
Provider Business Mailing Address Fax Number:
301-620-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 SOLAREX CT
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-7005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-620-1008
Provider Business Practice Location Address Fax Number:
301-620-1009
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEINBAR
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
PALMER
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
301-620-1008

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  S02182 , 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: 62201701 . This is a "RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7335426 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J4730002 . This is a "BCBS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: POO115547 . This is a "IDENTIFICATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 185A . This is a "BCBS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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