Provider Demographics
NPI:1710932215
Name:TERRAPIN CHIROPRACTIC
Entity Type:Organization
Organization Name:TERRAPIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-220-1930
Mailing Address - Street 1:9809 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1423
Mailing Address - Country:US
Mailing Address - Phone:301-220-1930
Mailing Address - Fax:301-220-1906
Practice Address - Street 1:9809 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1423
Practice Address - Country:US
Practice Address - Phone:301-220-1930
Practice Address - Fax:301-220-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMA01830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM605TEOtherBLUE CROSS & BLUE SHIELD
MDK581OtherCAREFIRST BC & BS
G02032Medicare ID - Type Unspecified