Healthcare Provider Details

I. General information

NPI: 1174615041
Provider Name (Legal Business Name): BEZAK CHIROPRACTIC AND REHABILITATION, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HANOVER PKWY STE 102
GREENBELT MD
20770-2011
US

IV. Provider business mailing address

7500 HANOVER PKWY STE 102
GREENBELT MD
20770-2011
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-0496
  • Fax: 301-220-2303
Mailing address:
  • Phone: 301-220-0496
  • Fax: 301-220-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUN MICHAEL BEZAK
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 301-220-0496