MEDICARE: MID-ATLANTIC CLINIC OF CHIROPRACTIC 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	111NR0400X	Rehabilitation Chiropractor	02013	MD

General Provider Information

NPI Number	:	1518030956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC CLINIC OF CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	7196 CRESTWOOD BLVD
Second Line	:	SUITE 100
City	:	FREDERICK
State	:	MD
Zip	:	21703-1844
Country	:	US
Telephone Number	:	301-698-0001
Fax Number	:	301-698-0031

Provider Business Practice Location Address
First Line	:	7196 CRESTWOOD BLVD
Second Line	:	SUITE 100
City	:	FREDERICK
State	:	MD
Zip	:	21703-1844
Country	:	US
Telephone Number	:	301-698-0001
Fax Number	:	301-698-0031

Authorized Official
Title or Position	:	OWNER
Name	:	AMIR RASHIDIAN
Credential	:	D.C.
Telephone Number	:	301-698-0001

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	12/17/2014

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