Provider Demographics
NPI:1326184128
Name:THE ATLANTIC PAIN CENTER, LLC
Entity Type:Organization
Organization Name:THE ATLANTIC PAIN CENTER, LLC
Other - Org Name:THE ATLANTIC PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:THORNTON
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-249-9355
Mailing Address - Street 1:1641 STATE ROUTE 3 N
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2925
Mailing Address - Country:US
Mailing Address - Phone:301-249-9355
Mailing Address - Fax:304-249-0404
Practice Address - Street 1:1641 STATE ROUTE 3 N
Practice Address - Street 2:SUITE 205
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2925
Practice Address - Country:US
Practice Address - Phone:301-249-9355
Practice Address - Fax:301-249-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty