Provider Demographics
NPI:1437212271
Name:BACK PAIN AND HEADACHE CENTERS LLC
Entity Type:Organization
Organization Name:BACK PAIN AND HEADACHE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOPELOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-654-0911
Mailing Address - Street 1:6708 WISCONSIN AVE
Mailing Address - Street 2:SUITE 206 3RD FL
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5300
Mailing Address - Country:US
Mailing Address - Phone:301-654-0911
Mailing Address - Fax:301-654-1658
Practice Address - Street 1:6708 WISCONSIN AVE
Practice Address - Street 2:SUITE 206 3RD FL
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5300
Practice Address - Country:US
Practice Address - Phone:301-654-0911
Practice Address - Fax:301-654-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LU65OtherPROVIDER NUMBER
S8310001OtherBLUE CROSS
LU65OtherPROVIDER NUMBER