Provider Demographics
NPI:1467573006
Name:NICOLE GANZ DC, CHIROPRACTOR LLC
Entity Type:Organization
Organization Name:NICOLE GANZ DC, CHIROPRACTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-929-8301
Mailing Address - Street 1:10400 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3910
Mailing Address - Country:US
Mailing Address - Phone:301-929-8301
Mailing Address - Fax:301-929-8302
Practice Address - Street 1:10400 CONNECTICUT AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3910
Practice Address - Country:US
Practice Address - Phone:301-929-8301
Practice Address - Fax:301-929-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS221 0001OtherCAREFIRST
MDM628OtherCAREFIRST
MD490429Medicare PIN
MDM628OtherCAREFIRST