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General NPI Number Information
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NPI Number | 1720422462
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 43 SOLOMONS ISLAND ROAD SUITE 201
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3852
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Country | US
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Telephone | 410-266-3888
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Fax |
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Provider Business Mailing Address
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Address Line | 43 SOLOMONS ISLAND ROAD SUITE 201
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3852
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Country | US
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Telephone | 410-266-3888
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. ANDREW GEORGE
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Credential | D.C.
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Telephone | 937-689-4601
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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 | S03744
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License Number State | MD
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