Provider Demographics
NPI:1265454177
Name:CALVERT CHIROPRACTIC
Entity Type:Organization
Organization Name:CALVERT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHURA
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ELLENBOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-286-8330
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-0351
Mailing Address - Country:US
Mailing Address - Phone:410-286-8330
Mailing Address - Fax:410-286-8332
Practice Address - Street 1:10339 SOUTHERN MARYLAND BLVD STE 207
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3018
Practice Address - Country:US
Practice Address - Phone:410-286-8330
Practice Address - Fax:410-286-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD807LMedicare ID - Type Unspecified
MDU65528Medicare UPIN