Provider Demographics
NPI:1922279462
Name:CORSICA FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CORSICA FAMILY CHIROPRACTIC, LLC
Other - Org Name:TUCKAHOE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-364-9222
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:QUEEN ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21657-0205
Mailing Address - Country:US
Mailing Address - Phone:410-364-9222
Mailing Address - Fax:410-364-9310
Practice Address - Street 1:32201 QUEEN ANNE HWY
Practice Address - Street 2:
Practice Address - City:QUEEN ANNE
Practice Address - State:MD
Practice Address - Zip Code:21657
Practice Address - Country:US
Practice Address - Phone:410-364-9222
Practice Address - Fax:410-364-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03460261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty