Provider Demographics
NPI:1518059443
Name:MCDERMOTT CHIROPRACTIC CENTRE LTD
Entity Type:Organization
Organization Name:MCDERMOTT CHIROPRACTIC CENTRE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OC CCSP
Authorized Official - Phone:410-569-1099
Mailing Address - Street 1:614 CRABAPPLE COURT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6032
Mailing Address - Country:US
Mailing Address - Phone:410-569-1099
Mailing Address - Fax:410-642-3552
Practice Address - Street 1:319 S UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3201
Practice Address - Country:US
Practice Address - Phone:410-939-1111
Practice Address - Fax:410-642-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
104646OtherJHHC
0001OtherBSDC
4400163OtherUNHC
5921641OtherAPPO
258998OtherAMOP
MD365452400Medicaid
P00046203OtherRRMC
31787OtherCOVE
53490401OtherBSMD
2020433OtherAHMO
2020433OtherAHMO
31787OtherCOVE
104646OtherJHHC
5921641OtherAPPO
=========OtherPIWC
104646OtherJHHC