Provider Demographics
NPI:1265413116
Name:RITTENHOUSE, BRENT (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:RITTENHOUSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:8608 LIBERTY RD
Practice Address - Street 2:LIBERTY COURT SHOPPING CENTER
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4707
Practice Address - Country:US
Practice Address - Phone:410-922-6900
Practice Address - Fax:410-922-7070
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD529005OtherCAREFIRST
MD1535431OtherCAQH
MD529005OtherCAREFIRST
MD477TMedicare ID - Type Unspecified