Provider Demographics
NPI:1073052353
Name:ANNAPOLIS PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ANNAPOLIS PAIN MANAGEMENT, LLC
Other - Org Name:GREEN LIFE CHIROPRACTIC & WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDT
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-224-4348
Mailing Address - Street 1:45 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3858
Mailing Address - Country:US
Mailing Address - Phone:410-224-4348
Mailing Address - Fax:410-224-4732
Practice Address - Street 1:45 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3858
Practice Address - Country:US
Practice Address - Phone:410-224-4348
Practice Address - Fax:410-224-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03711208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty