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General NPI Number Information
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NPI Number | 1114403045
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Entity Type | Organization
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Legal Business Name | MARYLAND CHIROPRACTIC & PHYSICAL MEDICINE LLC
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 137 MITCHELLS CHANCE RD STE 100
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City | EDGEWATER
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State | MD
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Zip | 21037-2793
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Country | US
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Telephone | 443-294-6873
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Fax | 443-294-6874
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Provider Business Mailing Address
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Address Line | 137 MITCHELLS CHANCE RD STE 100
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City | EDGEWATER
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State | MD
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Zip | 21037-2793
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DEREK CURRAN
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Credential | D.C.
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Telephone | 443-294-6873
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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 | S03774
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License Number State | MD
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