1801011895 NPI number — HOWARD COUNTY CHIROPRACTIC SPINE & SPORTS REHABILITATION. 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 1801011895 NPI number — HOWARD COUNTY CHIROPRACTIC SPINE & SPORTS REHABILITATION. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD COUNTY CHIROPRACTIC SPINE & SPORTS REHABILITATION. 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:
1801011895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8894 STANFORD BLVD
Provider Second Line Business Mailing Address:
SUITE I02
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-4794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-259-0235
Provider Business Mailing Address Fax Number:
443-259-0236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8894 STANFORD BLVD
Provider Second Line Business Practice Location Address:
SUITE I02
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-4794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-259-0235
Provider Business Practice Location Address Fax Number:
443-259-0236
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANTICO
Authorized Official First Name:
RUSSEL
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
443-259-0235

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  S01939 , 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)





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