Provider Demographics
NPI:1497965123
Name:CLARKSVILLE CHIROPRACTIC HEALTH CENTER, PA
Entity Type:Organization
Organization Name:CLARKSVILLE CHIROPRACTIC HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-854-3800
Mailing Address - Street 1:6363 TEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1186
Mailing Address - Country:US
Mailing Address - Phone:301-854-3800
Mailing Address - Fax:410-531-9814
Practice Address - Street 1:6363 TEN OAKS RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1186
Practice Address - Country:US
Practice Address - Phone:301-854-3800
Practice Address - Fax:410-531-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT5660001OtherBLUE CROSS BLUE SHIELD DC
MDKV41OtherBLUE CROSS BLUE SHIELD MD
MDT5660001OtherBLUE CROSS BLUE SHIELD DC