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General NPI Number Information
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NPI Number | 1992314090
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Entity Type | Organization
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Legal Business Name | 360 REHABILITATION & CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 2010 CLIPPER PARK RD STE 117
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City | BALTIMORE
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State | MD
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Zip | 21211-1439
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Country | US
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Telephone | 407-712-4679
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Fax |
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Provider Business Mailing Address
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Address Line | 17 BENSMILL CT STE 117
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City | REISTERSTOWN
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State | MD
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Zip | 21136-6459
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Country | US
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Telephone | 407-712-4679
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ANNA WELTY
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Credential | DC
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Telephone | 407-712-4679
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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 |
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License Number State |
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