Healthcare Provider Details

I. General information

NPI: 1356997530
Provider Name (Legal Business Name): KAIZEN CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 MONTGOMERY AVE STE 404
BETHESDA MD
20814-3431
US

IV. Provider business mailing address

4641 MONTGOMERY AVE STE 404
BETHESDA MD
20814-3431
US

V. Phone/Fax

Practice location:
  • Phone: 240-670-0081
  • Fax:
Mailing address:
  • Phone: 240-670-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L DAVIS
Title or Position: DIRECTOR OF SPORT MEDICINE
Credential: DC
Phone: 240-670-0081