Provider Demographics
NPI:1407035181
Name:NATIONAL CHIROPRACTIC HEALTH & SPORTS REHABILITATION, INC
Entity Type:Organization
Organization Name:NATIONAL CHIROPRACTIC HEALTH & SPORTS REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-531-8000
Mailing Address - Street 1:9501 OLD ANNAPOLIS ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6335
Mailing Address - Country:US
Mailing Address - Phone:410-531-8000
Mailing Address - Fax:410-531-1917
Practice Address - Street 1:9501 OLD ANNAPOLIS ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6335
Practice Address - Country:US
Practice Address - Phone:410-531-8000
Practice Address - Fax:410-531-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02287Medicare UPIN
MDU11776Medicare UPIN
MDK511Medicare PIN