Provider Demographics
NPI:1306025028
Name:CHIROPRACTIC & PT CENTER OF TURF VALLEY, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC & PT CENTER OF TURF VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR/PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:DOLENGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-461-0080
Mailing Address - Street 1:10729 BIRMINGHAM WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1403
Mailing Address - Country:US
Mailing Address - Phone:410-461-0080
Mailing Address - Fax:410-461-8566
Practice Address - Street 1:10729 BIRMINGHAM WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1403
Practice Address - Country:US
Practice Address - Phone:410-461-0080
Practice Address - Fax:410-461-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN162-0001OtherCAREFIRST BCBS
MD1077382OtherAETNA
MD4114301OtherUNITED HC/MAMSI
MD620634-02OtherCAREFIRST BCBS
MD89175Medicare UPIN
MDN162-0001OtherCAREFIRST BCBS