Provider Demographics
NPI:1922295948
Name:TWO CHICKS, LLC
Entity Type:Organization
Organization Name:TWO CHICKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:WALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-349-2727
Mailing Address - Street 1:530 COLLEGE PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 COLLEGE PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4614
Practice Address - Country:US
Practice Address - Phone:410-349-2727
Practice Address - Fax:410-349-4605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROADNECK FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-03
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01998111N00000X
MD01760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD582QMedicare UPIN
MD456M669FMedicare UPIN