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General NPI Number Information
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NPI Number | 1346534070
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Entity Type | Organization
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Legal Business Name | UPSTAT PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 05/28/2011
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 6420 DOBBIN RD SUITE A
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City | COLUMBIA
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State | MD
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Zip | 21045-4749
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Country | US
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Telephone | 443-524-6600
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Fax | 443-524-6608
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Provider Business Mailing Address
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Address Line | 220 W COLD SPRING LN
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City | BALTIMORE
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State | MD
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Zip | 21210-2802
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Country | US
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Telephone | 443-524-6600
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Fax | 443-524-6608
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC ROSS HUNTINGTON
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Credential | DC
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Telephone | 443-992-3685
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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 | S02029
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License Number State | MD
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