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General NPI Number Information
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NPI Number | 1285005710
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Entity Type | Organization
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Legal Business Name | IMAGINE ENTERPRISES INC.
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 6020 MEADOWRIDGE CENTER DR UNIT E
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City | ELKRIDGE
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State | MD
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Zip | 21075-6528
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Country | US
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Telephone | 443-845-3379
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Fax | 443-212-5766
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Provider Business Mailing Address
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Address Line | 10 FILA WAY STE 201-A
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City | SPARKS
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State | MD
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Zip | 21152-9452
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Country | US
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Telephone | 443-845-3379
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Fax | 443-212-5766
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SPENCER H BRANNAN
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Credential |
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Telephone | 443-845-3379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U01832
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License Number State | MD
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