Healthcare Provider Details

I. General information

NPI: 1487094769
Provider Name (Legal Business Name): HARMONIOUS LIVING CHIROPRACTIC: FITNESS & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8288 TELEGRAPH RD SUITE A
ODENTON MD
21113-1130
US

IV. Provider business mailing address

8288 TELEGRAPH RD SUITE A
ODENTON MD
21113-1130
US

V. Phone/Fax

Practice location:
  • Phone: 410-695-6045
  • Fax:
Mailing address:
  • Phone: 410-695-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS03598
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberS03598
License Number StateMD

VIII. Authorized Official

Name: DR. TIFFANY T BUTLER
Title or Position: OWNER
Credential: D.C.
Phone: 410-695-6045