Healthcare Provider Details

I. General information

NPI: 1811408339
Provider Name (Legal Business Name): LIFE CHIROPRACTIC OF OLNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18120 HILLCREST AVE STE D
OLNEY MD
20832-1444
US

IV. Provider business mailing address

18120 HILLCREST AVE STE D
OLNEY MD
20832-1444
US

V. Phone/Fax

Practice location:
  • Phone: 301-924-6444
  • Fax: 301-924-6444
Mailing address:
  • Phone: 301-924-6444
  • Fax: 301-774-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS03726
License Number StateMD

VIII. Authorized Official

Name: ROSANNA L STREAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-924-6444