Healthcare Provider Details

I. General information

NPI: 1427119296
Provider Name (Legal Business Name): CAMBRIDGE CHIROPRACTIC CENTER, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MARYLAND AVE
CAMBRIDGE MD
21613-1927
US

IV. Provider business mailing address

421 MARYLAND AVE
CAMBRIDGE MD
21613-1927
US

V. Phone/Fax

Practice location:
  • Phone: 410-221-0781
  • Fax: 410-476-3400
Mailing address:
  • Phone: 410-221-0781
  • Fax: 410-476-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number004731
License Number StateMD

VIII. Authorized Official

Name: DR. TERRANCE FENERTY
Title or Position: OWNER
Credential: DC
Phone: 410-221-0781