Healthcare Provider Details

I. General information

NPI: 1063687044
Provider Name (Legal Business Name): MARYLAND HEALTHCARE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 FREDERICK AVE
BALTIMORE MD
21223-2856
US

IV. Provider business mailing address

6615 REISTERSTOWN RD FIRST FLOOR
BALTIMORE MD
21215-2686
US

V. Phone/Fax

Practice location:
  • Phone: 410-945-6018
  • Fax: 410-945-4076
Mailing address:
  • Phone: 410-318-6253
  • Fax: 410-358-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROMAN BALAKIRSKY
Title or Position: VICE PRESIDENT
Credential:
Phone: 410-358-3200