Healthcare Provider Details

I. General information

NPI: 1376762260
Provider Name (Legal Business Name): MARTY V CAIRNS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 N POTOMAC ST
HAGERSTOWN MD
21740-3821
US

IV. Provider business mailing address

479 N POTOMAC ST
HAGERSTOWN MD
21740-3821
US

V. Phone/Fax

Practice location:
  • Phone: 301-739-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1462
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: