Provider Demographics
NPI:1164606737
Name:HEALTHBRIDGE CHIROPRACTIC
Entity Type:Organization
Organization Name:HEALTHBRIDGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MENGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-638-2424
Mailing Address - Street 1:1416 MARTIN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2221
Mailing Address - Country:US
Mailing Address - Phone:410-877-1597
Mailing Address - Fax:
Practice Address - Street 1:137 E BROADWAY
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2903
Practice Address - Country:US
Practice Address - Phone:410-638-2424
Practice Address - Fax:410-893-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01933111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD639A-HEOtherBCBS PROVIDER GROUP #
MD60485304OtherBLUE SHIELD RENDERING ID#
MDJ5830001OtherBS FEP, BLUE CHOICE
MD60485304OtherBLUE SHIELD RENDERING ID#
U79715Medicare UPIN
MD027N 856FMedicare PIN