Provider Demographics
NPI:1770741175
Name:CANADIAN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CANADIAN CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-256-8511
Mailing Address - Street 1:8007 CORPORATE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4905
Mailing Address - Country:US
Mailing Address - Phone:410-256-8511
Mailing Address - Fax:410-256-1810
Practice Address - Street 1:8007 CORPORATE DR
Practice Address - Street 2:SUITE E
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4905
Practice Address - Country:US
Practice Address - Phone:410-256-8511
Practice Address - Fax:410-256-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD167637Medicare UPIN