Provider Demographics
NPI:1134302797
Name:MERCY CHIROPRACTIC AND REHABILITATION CLINIC, LLP
Entity Type:Organization
Organization Name:MERCY CHIROPRACTIC AND REHABILITATION CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-465-3221
Mailing Address - Street 1:9005 CHEVROLET DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4009
Mailing Address - Country:US
Mailing Address - Phone:410-465-3514
Mailing Address - Fax:
Practice Address - Street 1:9005 CHEVROLET DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4009
Practice Address - Country:US
Practice Address - Phone:410-465-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty