Provider Demographics
NPI:1255544409
Name:HEAD,NECK & BACK PAIN CENTER P.A.
Entity type:Organization
Organization Name:HEAD,NECK & BACK PAIN CENTER P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:410-665-6666
Mailing Address - Street 1:1703 E JOPPA RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3638
Mailing Address - Country:US
Mailing Address - Phone:410-665-6666
Mailing Address - Fax:410-882-1264
Practice Address - Street 1:1703 E JOPPA RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3638
Practice Address - Country:US
Practice Address - Phone:410-665-6666
Practice Address - Fax:410-882-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1450111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52641OtherCHIROPRACTOR
MD680LMedicare ID - Type UnspecifiedCHIROPRACTOR
MDU31319Medicare UPIN