Healthcare Provider Details

I. General information

NPI: 1942286182
Provider Name (Legal Business Name): THOMAS M. KLINE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
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: 301-645-2989
  • Fax: 301-843-5917
Mailing address:
  • Phone: 301-645-2989
  • 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:
Title or Position:
Credential:
Phone: