Provider Demographics
NPI:1841590718
Name:SEYMORE CHIROPRACTIC & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SEYMORE CHIROPRACTIC & PHYSICAL THERAPY
Other - Org Name:MARYLAND SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SEYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DC, DIBE, CCCN
Authorized Official - Phone:410-877-8077
Mailing Address - Street 1:730 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4244
Mailing Address - Country:US
Mailing Address - Phone:410-877-8077
Mailing Address - Fax:410-877-8577
Practice Address - Street 1:730 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4244
Practice Address - Country:US
Practice Address - Phone:410-877-8077
Practice Address - Fax:410-877-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20804-PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113NM774OtherLEGACY #
MD113NM774OtherLEGACY #