Provider Demographics
NPI:1013160456
Name:CHARLES D. CRUICKSHANK, D.C., P.A.
Entity Type:Organization
Organization Name:CHARLES D. CRUICKSHANK, D.C., P.A.
Other - Org Name:BALTIMORE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CRUICKSHANK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-529-3913
Mailing Address - Street 1:8615 RIDGELYS CHOICE DR
Mailing Address - Street 2:104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3026
Mailing Address - Country:US
Mailing Address - Phone:410-529-3913
Mailing Address - Fax:410-529-3916
Practice Address - Street 1:8615 RIDGELYS CHOICE DR
Practice Address - Street 2:104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3026
Practice Address - Country:US
Practice Address - Phone:410-529-3913
Practice Address - Fax:410-529-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01776261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD691QOtherMEDICARE
MDM563OtherCAREFIRST BLUECROSS BLUESHIELD
MDW3720001OtherGHMSI