Provider Demographics
NPI:1518030956
Name:MID-ATLANTIC CLINIC OF CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC CLINIC OF CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-698-0001
Mailing Address - Street 1:7196 CRESTWOOD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-1844
Mailing Address - Country:US
Mailing Address - Phone:301-698-0001
Mailing Address - Fax:301-698-0031
Practice Address - Street 1:7196 CRESTWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-1844
Practice Address - Country:US
Practice Address - Phone:301-698-0001
Practice Address - Fax:301-698-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02013111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty