=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366586687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE CARE CHIROPRACTIC AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 POST OFFICE RD STE 102
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-870-9616
-----------------------------------------------------
Fax | 301-645-1252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 POST OFFICE RD STE 102
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-870-9616
-----------------------------------------------------
Fax | 301-645-1252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. RONDA LYNN SHARMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 301-870-9616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | S01828
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------