Provider Demographics
NPI:1437419934
Name:WHEATON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WHEATON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-962-3500
Mailing Address - Street 1:9801 GEORGIA AVE STE 339
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-962-3500
Mailing Address - Fax:301-962-3700
Practice Address - Street 1:9801 GEORGIA AVE STE 339
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-962-3500
Practice Address - Fax:301-962-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty