Healthcare Provider Details

I. General information

NPI: 1619148608
Provider Name (Legal Business Name): THOMAS M. KLINE D.C.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11637 TERRACE DR SUITE 101
WALDORF MD
20602-3706
US

IV. Provider business mailing address

11637 TERRACE DR SUITE 101
WALDORF MD
20602-3706
US

V. Phone/Fax

Practice location:
  • Phone: 301-843-1156
  • Fax: 301-843-5917
Mailing address:
  • Phone: 301-843-1156
  • Fax: 301-843-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1197PT
License Number StateMD

VIII. Authorized Official

Name: DR. THOMAS KLINE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 301-843-1156