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General NPI Number Information
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NPI Number | 1083346159
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Entity Type | Organization
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Legal Business Name | SPRING RIDGE CHIROPRACTIC OF BOONSBORO LLC
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 20311 LAPPANS RD UNIT 102
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City | BOONSBORO
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State | MD
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Zip | 21713-2086
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Country | US
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Telephone | 301-620-8566
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Fax | 301-620-8568
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Provider Business Mailing Address
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Address Line | 20311 LAPPANS RD UNIT 102
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City | BOONSBORO
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State | MD
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Zip | 21713-2086
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Country | US
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Telephone | 301-620-8566
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Fax | 301-620-8568
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Authorized Official
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Title or Position | OWNER/DR
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Name | LISA D ORTIZ
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Credential | DC
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Telephone | 301-620-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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