Provider Demographics
NPI:1790195238
Name:ROLAND PARK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ROLAND PARK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SILKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-380-6897
Mailing Address - Street 1:6307 BOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2211
Mailing Address - Country:US
Mailing Address - Phone:971-238-9670
Mailing Address - Fax:443-815-4778
Practice Address - Street 1:6301 N CHARLES ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1040
Practice Address - Country:US
Practice Address - Phone:443-841-7817
Practice Address - Fax:443-815-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5560261Q00000X
MDC16813261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center