Healthcare Provider Details

I. General information

NPI: 1457088122
Provider Name (Legal Business Name): CHESAPEAKE INTEGRATIVE HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DUKE ST STE 107
PRINCE FREDERICK MD
20678-6128
US

IV. Provider business mailing address

134 CALVERT TOWNE RD
PRINCE FREDERICK MD
20678-4100
US

V. Phone/Fax

Practice location:
  • Phone: 443-532-8331
  • Fax:
Mailing address:
  • Phone: 443-532-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ERIKA KAINE BOTTALICO
Title or Position: RDH, OMT
Credential: RDH
Phone: 443-532-8331