Healthcare Provider Details

I. General information

NPI: 1598975146
Provider Name (Legal Business Name): SEYMORE CHIROPRACTIC AND PHYSICAL THERAPY CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BALTIMORE PIKE
BEL AIR MD
21014-4244
US

IV. Provider business mailing address

730 BALTIMORE PIKE
BEL AIR MD
21014-4244
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-8077
  • Fax: 410-877-8577
Mailing address:
  • Phone: 410-877-8077
  • Fax: 410-877-8577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0013 CCCN
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20804 PT
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20804
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number03390
License Number StateMD

VIII. Authorized Official

Name: DR. BRIAN L SEYMORE
Title or Position: PRESIDENT
Credential: DC,PT,CCCN,R.EDT
Phone: 410-877-8077