Provider Demographics
NPI:1114050515
Name:DEER PARK CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:DEER PARK CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-990-4184
Mailing Address - Street 1:604 S FREDERICK AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1275
Mailing Address - Country:US
Mailing Address - Phone:301-990-4184
Mailing Address - Fax:301-990-4187
Practice Address - Street 1:604 S FREDERICK AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1275
Practice Address - Country:US
Practice Address - Phone:301-990-4184
Practice Address - Fax:301-990-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty