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General NPI Number Information
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NPI Number | 1467573006
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Entity Type | Organization
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Legal Business Name | NICOLE GANZ DC, CHIROPRACTOR LLC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 10400 CONNECTICUT AVE SUITE 314
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City | KENSINGTON
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State | MD
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Zip | 20895-3910
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Country | US
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Telephone | 301-929-8301
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Fax | 301-929-8302
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Provider Business Mailing Address
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Address Line | 10400 CONNECTICUT AVE SUITE 314
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City | KENSINGTON
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State | MD
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Zip | 20895-3910
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Country | US
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Telephone | 301-929-8301
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Fax | 301-929-8302
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE GANZ
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Credential | D.C.
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Telephone | 301-929-8301
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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 | 01894
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License Number State | MD
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