Provider Demographics
NPI:1952640757
Name:TOWN CENTER CHIROPRACTIC OF COLUMBIA PC
Entity Type:Organization
Organization Name:TOWN CENTER CHIROPRACTIC OF COLUMBIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-992-7730
Mailing Address - Street 1:10630 LITTLE PATUXENT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6208
Mailing Address - Country:US
Mailing Address - Phone:410-992-7330
Mailing Address - Fax:410-992-7731
Practice Address - Street 1:10630 LITTLE PATUXENT PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-992-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty