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General NPI Number Information
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NPI Number | 1518059443
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Entity Type | Organization
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Legal Business Name | MCDERMOTT CHIROPRACTIC CENTRE LTD
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 319 S UNION AVE
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3201
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Country | US
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Telephone | 410-939-1111
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Fax | 410-642-3552
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Provider Business Mailing Address
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Address Line | 614 CRABAPPLE COURT
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City | BEL AIR
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State | MD
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Zip | 21015-6032
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Country | US
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Telephone | 410-569-1099
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Fax | 410-642-3552
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM ROBERT MCDERMOTT
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Credential | OC CCSP
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Telephone | 410-569-1099
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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 | 1540
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License Number State | MD
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