Provider Demographics
NPI:1831118033
Name:HEALING ARTS CENTER OF MARYLAND LLC
Entity Type:Organization
Organization Name:HEALING ARTS CENTER OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-931-2096
Mailing Address - Street 1:5022 CAMPBELL BLVD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4931
Mailing Address - Country:US
Mailing Address - Phone:410-931-2096
Mailing Address - Fax:410-931-2106
Practice Address - Street 1:5022 CAMPBELL BLVD.
Practice Address - Street 2:SUITE D
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4931
Practice Address - Country:US
Practice Address - Phone:410-931-2096
Practice Address - Fax:410-931-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20BRMDOtherBCBS
MD5470-0001OtherCFBC
629447OtherUHC
MD20BRMDOtherBCBS
MD5470-0001OtherCFBC