Healthcare Provider Details

I. General information

NPI: 1558618249
Provider Name (Legal Business Name): BRIAN K. DRAGAN, D.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 RITCHIE HWY
GLEN BURNIE MD
21061-3716
US

IV. Provider business mailing address

502 FOREST VIEW RD
LINTHICUM HEIGHTS MD
21090-2818
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-1444
  • Fax: 410-768-5703
Mailing address:
  • Phone: 443-310-8613
  • Fax: 410-768-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01433
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS01433
License Number StateMD

VIII. Authorized Official

Name: DR. BRIAN K. DRAGAN
Title or Position: CHIROPRACTOR
Credential:
Phone: 410-766-1444