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General NPI Number Information
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NPI Number | 1235369935
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Entity Type | Organization
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Legal Business Name | D SHANE CRADIC DC LLC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 8701 GEORGIA AVE SUITE 507
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City | SILVER SPRING
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State | MD
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Zip | 20910-3713
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Country | US
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Telephone | 301-608-1545
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Fax | 301-608-1547
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Provider Business Mailing Address
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Address Line | 8701 GEORGIA AVE SUITE 507
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City | SILVER SPRING
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State | MD
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Zip | 20910-3713
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Country | US
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Telephone | 301-608-1545
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Fax | 301-608-1547
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DAVID S. CRADIC
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Credential | D.C.
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Telephone | 301-608-1545
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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 | 03425
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License Number State | MD
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