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General NPI Number Information
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NPI Number | 1346429842
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Entity Type | Organization
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Legal Business Name | MARLBORO INJURY AND HEALING CENTER
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 2810 WALTERS LN
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City | FORESTVILLE
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State | MD
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Zip | 20747-3247
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Country | US
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Telephone | 301-420-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 WALTERS LN
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City | FORESTVILLE
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State | MD
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Zip | 20747-3247
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Country | US
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Telephone | 301-420-8888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JACQUELINE JACKSON
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Credential |
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Telephone | 301-420-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | S02081
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License Number State | MD
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