Provider Demographics
NPI:1639491343
Name:PREFERRED CARE CENTER OF GLEN BURNIE LLC
Entity Type:Organization
Organization Name:PREFERRED CARE CENTER OF GLEN BURNIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:GULITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-842-5500
Mailing Address - Street 1:PO BOX 69140
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9140
Mailing Address - Country:US
Mailing Address - Phone:410-766-1144
Mailing Address - Fax:410-766-1330
Practice Address - Street 1:7389 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3270
Practice Address - Country:US
Practice Address - Phone:410-766-1144
Practice Address - Fax:410-766-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty