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General NPI Number Information
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NPI Number | 1629100748
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Entity Type | Organization
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Legal Business Name | RIVERDALE CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6105 57TH AVE SUITE 200
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City | RIVERDALE
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State | MD
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Zip | 20737-2125
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Country | US
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Telephone | 301-779-2225
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Fax | 301-277-6688
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Provider Business Mailing Address
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Address Line | 6105 57TH AVE SUITE 200
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City | RIVERDALE
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State | MD
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Zip | 20737-2125
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Country | US
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Telephone | 301-779-2225
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Fax | 301-277-6688
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EHSAN KHADEMI
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Credential | D.C.
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Telephone | 301-779-2225
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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 | 1795
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License Number State | MD
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