Healthcare Provider Details

I. General information

NPI: 1699983429
Provider Name (Legal Business Name): CARROLLTON CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 85TH AVE
NEW CARROLLTON MD
20784-2927
US

IV. Provider business mailing address

5706 85TH AVE
NEW CARROLLTON MD
20784-2927
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-0023
  • Fax: 301-577-0095
Mailing address:
  • Phone: 301-577-0023
  • Fax: 301-577-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01785
License Number StateMD

VIII. Authorized Official

Name: DR. CARL JOSEPH HEUSLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 301-577-0023