Healthcare Provider Details

I. General information

NPI: 1225299837
Provider Name (Legal Business Name): KENT ISLAND CHIROPRACTIC AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 MAIN ST. SUITE C
CHESTER MD
21619
US

IV. Provider business mailing address

1812 MAIN ST. SUITE C
CHESTER MD
21619
US

V. Phone/Fax

Practice location:
  • Phone: 443-249-3168
  • Fax: 443-249-3199
Mailing address:
  • Phone: 443-249-3168
  • Fax: 443-249-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number03507
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LANAE N BAKER
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 443-249-3168