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General NPI Number Information
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NPI Number | 1477043073
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Entity Type | Organization
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Legal Business Name | COMPLETE CHIROPRACTIC AND REHABILITATION, LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 3720 FARRAGUT AVE STE 401
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City | KENSINGTON
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State | MD
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Zip | 20895
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Country | US
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Telephone | 240-242-3444
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Fax | 240-669-8853
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Provider Business Mailing Address
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Address Line | 3720 FARRAGUT AVE STE 401
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City | KENSINGTON
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State | MD
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Zip | 20895-2140
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Country | US
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Telephone | 240-242-3444
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Fax | 240-669-8853
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. TARA Z. KERN
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Credential | DC
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Telephone | 240-242-3444
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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 | S03946
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License Number State | MD
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