Provider Demographics
NPI:1235230442
Name:FORT WASHINGTON CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FORT WASHINGTON CHIROPRACTIC CENTER
Other - Org Name:CHIROPRACTIC PROFESSIONAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-292-7500
Mailing Address - Street 1:10903 INDIAN HEAD HWY
Mailing Address - Street 2:SUITE 506
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4000
Mailing Address - Country:US
Mailing Address - Phone:301-292-7500
Mailing Address - Fax:301-203-1511
Practice Address - Street 1:10903 INDIAN HEAD HWY
Practice Address - Street 2:SUITE 506
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4000
Practice Address - Country:US
Practice Address - Phone:301-292-7500
Practice Address - Fax:301-203-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU92644Medicare UPIN