Provider Demographics
NPI:1659761104
Name:GERMANTOWN CHIROPRACTIC & WELLNESS PC
Entity Type:Organization
Organization Name:GERMANTOWN CHIROPRACTIC & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-540-3111
Mailing Address - Street 1:19508 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5200
Mailing Address - Country:US
Mailing Address - Phone:301-540-3111
Mailing Address - Fax:240-837-1731
Practice Address - Street 1:19508 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5200
Practice Address - Country:US
Practice Address - Phone:301-540-3111
Practice Address - Fax:240-837-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T73461Medicare UPIN
531371Medicare PIN