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General NPI Number Information
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NPI Number | 1255774691
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH MEDICAL AND PAIN RELIEF CENTER LLC
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 12106 OLD LINE CTR
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City | WALDORF
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State | MD
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Zip | 20602-2553
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Country | US
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Telephone | 301-545-8898
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Fax |
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Provider Business Mailing Address
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Address Line | 12106 OLD LINE CTR
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City | WALDORF
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State | MD
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Zip | 20602-2553
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Country | US
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Telephone | 301-545-8898
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN LIPSITZ
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Credential |
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Telephone | 301-545-8898
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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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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0060828
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MD
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