Healthcare Provider Details

I. General information

NPI: 1265454177
Provider Name (Legal Business Name): CALVERT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10339 SOUTHERN MARYLAND BLVD STE 207
DUNKIRK MD
20754-3018
US

IV. Provider business mailing address

PO BOX 351
DUNKIRK MD
20754-0351
US

V. Phone/Fax

Practice location:
  • Phone: 410-286-8330
  • Fax: 410-286-8332
Mailing address:
  • Phone: 410-286-8330
  • Fax: 410-286-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01815
License Number StateMD

VIII. Authorized Official

Name: JOSHURA JAY ELLENBOGEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 410-286-8330