Provider Demographics
NPI:1164527040
Name:FREDERICK CHIROPRACTIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:FREDERICK CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-695-0032
Mailing Address - Street 1:5301 BUCKEYSTOWN PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8365
Mailing Address - Country:US
Mailing Address - Phone:301-695-0032
Mailing Address - Fax:
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE STE 210
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8365
Practice Address - Country:US
Practice Address - Phone:301-695-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD326M445FMedicare ID - Type Unspecified