Provider Demographics
NPI:1598705709
Name:COHEN, NEIL BRUCE (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:BRUCE
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3423
Mailing Address - Country:US
Mailing Address - Phone:410-686-8400
Mailing Address - Fax:
Practice Address - Street 1:1308 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3423
Practice Address - Country:US
Practice Address - Phone:410-686-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01560PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
533QMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
T53137Medicare UPIN
4017290001Medicare NSC