Healthcare Provider Details

I. General information

NPI: 1083897300
Provider Name (Legal Business Name): LA PLATA FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CENTENNIAL ST
LA PLATA MD
20646-2741
US

IV. Provider business mailing address

PO BOX 2741 203 CENTENNIAL ST
LA PLATA MD
20646-2741
US

V. Phone/Fax

Practice location:
  • Phone: 301-932-2100
  • Fax: 301-392-9338
Mailing address:
  • Phone: 301-932-2100
  • Fax: 301-392-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberSO1429
License Number StateMD

VIII. Authorized Official

Name: DR. FRANK ALFANO
Title or Position: DOCTOR
Credential: D.C.
Phone: 301-932-2100