Provider Demographics
NPI:1073889655
Name:MARYLAND FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:MARYLAND FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-831-9026
Mailing Address - Street 1:1835 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 322
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4600
Mailing Address - Country:US
Mailing Address - Phone:301-408-0061
Mailing Address - Fax:301-408-0063
Practice Address - Street 1:1835 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 322
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4600
Practice Address - Country:US
Practice Address - Phone:301-408-0061
Practice Address - Fax:301-408-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty