Provider Demographics
NPI:1114398401
Name:ADVANTAGE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GINSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-740-5075
Mailing Address - Street 1:12401 MIDDLEBROOK RD
Mailing Address - Street 2:#190
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1525
Mailing Address - Country:US
Mailing Address - Phone:301-353-9676
Mailing Address - Fax:301-353-9435
Practice Address - Street 1:12401 MIDDLEBROOK RD
Practice Address - Street 2:#190
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1525
Practice Address - Country:US
Practice Address - Phone:301-353-9676
Practice Address - Fax:301-353-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty