Provider Demographics
NPI:1346534070
Name:UPSTAT PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:UPSTAT PROFESSIONAL SERVICES, LLC
Other - Org Name:LIVING WELLNESS CHIROPRACTIC OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-992-3685
Mailing Address - Street 1:220 W COLD SPRING LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2802
Mailing Address - Country:US
Mailing Address - Phone:443-524-6600
Mailing Address - Fax:443-524-6608
Practice Address - Street 1:6420 DOBBIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4749
Practice Address - Country:US
Practice Address - Phone:443-524-6600
Practice Address - Fax:443-524-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-28
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty