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General NPI Number Information
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NPI Number | 1184243859
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Entity Type | Organization
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Legal Business Name | CRC WELLNESS DUNDALK
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1123 MERRITT BLVD
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City | DUNDALK
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State | MD
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Zip | 21222-1438
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Country | US
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Telephone | 410-451-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 CRONSON BLVD STE F
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City | CROFTON
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State | MD
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Zip | 21114-2064
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Country | US
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Telephone | 410-451-3561
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGERE
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Name | MARIA CASCICO
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Credential |
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Telephone | 410-451-3561
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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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