Provider Demographics
NPI:1801043955
Name:CHIROPRACTIC CARE CENTER INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MOSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-638-4300
Mailing Address - Street 1:957 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2800
Mailing Address - Country:US
Mailing Address - Phone:301-638-4300
Mailing Address - Fax:301-638-1090
Practice Address - Street 1:957 CHANDLER CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2800
Practice Address - Country:US
Practice Address - Phone:301-638-4300
Practice Address - Fax:301-638-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1890111N00000X
MD1891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU72764Medicare UPIN