Provider Demographics
NPI:1508485525
Name:AAA LUMBAR CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:AAA LUMBAR CHIROPRACTIC LLC
Other - Org Name:CLARK CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-926-1500
Mailing Address - Street 1:418 E DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3018
Mailing Address - Country:US
Mailing Address - Phone:301-926-1500
Mailing Address - Fax:301-926-0462
Practice Address - Street 1:418 E DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3018
Practice Address - Country:US
Practice Address - Phone:301-926-1500
Practice Address - Fax:301-926-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty