Provider Demographics
NPI:1083346159
Name:SPRING RIDGE CHIROPRACTIC OF BOONSBORO LLC
Entity Type:Organization
Organization Name:SPRING RIDGE CHIROPRACTIC OF BOONSBORO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-620-8566
Mailing Address - Street 1:20311 LAPPANS RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-2086
Mailing Address - Country:US
Mailing Address - Phone:301-620-8566
Mailing Address - Fax:301-620-8568
Practice Address - Street 1:20311 LAPPANS RD UNIT 102
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2086
Practice Address - Country:US
Practice Address - Phone:301-620-8566
Practice Address - Fax:301-620-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS01856OtherSTATE LICENSE
MDS01857OtherSTATE LICENSE
MDS04024OtherSTATE LICENSE