Healthcare Provider Details

I. General information

NPI: 1164606737
Provider Name (Legal Business Name): HEALTHBRIDGE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 E BROADWAY
BEL AIR MD
21014-2903
US

IV. Provider business mailing address

1416 MARTIN MEADOWS DR
FALLSTON MD
21047-2221
US

V. Phone/Fax

Practice location:
  • Phone: 410-638-2424
  • Fax: 410-893-8923
Mailing address:
  • Phone: 410-877-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01933
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number01933
License Number StateMD

VIII. Authorized Official

Name: DR. JASON RICHARD MENGES
Title or Position: SOLE OWNER
Credential: D.C.
Phone: 410-638-2424