Healthcare Provider Details

I. General information

NPI: 1235122086
Provider Name (Legal Business Name): PASADENA NECK AND BACK PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8096 EDWIN RAYNOR BLVD STE A
PASADENA MD
21122-6837
US

IV. Provider business mailing address

8096 EDWIN RAYNOR BLVD STE A
PASADENA MD
21122-6837
US

V. Phone/Fax

Practice location:
  • Phone: 410-360-0014
  • Fax: 410-360-0064
Mailing address:
  • Phone: 410-360-0014
  • Fax: 410-360-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01558
License Number StateMD

VIII. Authorized Official

Name: RAYMOND K BARRY
Title or Position: OWNER
Credential: DC
Phone: 410-360-0014