Provider Demographics
NPI:1649562711
Name:HARBOR BAY CLINIC OF CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HARBOR BAY CLINIC OF CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-237-8281
Mailing Address - Street 1:45319 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:PINEY POINT
Mailing Address - State:MD
Mailing Address - Zip Code:20674-3112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23620 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3082
Practice Address - Country:US
Practice Address - Phone:240-237-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03634261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center