Provider Demographics
NPI:1114403045
Name:MARYLAND CHIROPRACTIC & PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:MARYLAND CHIROPRACTIC & PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-294-6873
Mailing Address - Street 1:137 MITCHELLS CHANCE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 MITCHELLS CHANCE RD STE 100
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2793
Practice Address - Country:US
Practice Address - Phone:443-294-6873
Practice Address - Fax:443-294-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty