Healthcare Provider Details

I. General information

NPI: 1548395262
Provider Name (Legal Business Name): COLUMBIA ADVANCED CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 COLUMBIA 100 PKWY SUITE D
COLUMBIA MD
21045-2147
US

IV. Provider business mailing address

8835 COLUMBIA 100 PKWY SUITE D
COLUMBIA MD
21045-2147
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-3229
  • Fax: 410-964-9671
Mailing address:
  • Phone: 410-964-3229
  • Fax: 410-964-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1898PT
License Number StateMD

VIII. Authorized Official

Name: DR. ALLEN M MANISON
Title or Position: MANAGING MEMBER LLC
Credential: D.C.
Phone: 410-964-3229