MEDICARE: MARYLAND CHIROPRACTIC & PHYSICAL MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	S03774	MD

General Provider Information

NPI Number	:	1114403045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND CHIROPRACTIC & PHYSICAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	137 MITCHELLS CHANCE RD STE 100
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-2793
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 MITCHELLS CHANCE RD STE 100
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-2793
Country	:	US
Telephone Number	:	443-294-6873
Fax Number	:	443-294-6874

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DEREK CURRAN
Credential	:	D.C.
Telephone Number	:	443-294-6873

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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