Provider Demographics
NPI:1811050784
Name:BACK AND NECK CARE CENTERS OF DRS FRIDAY & MANGANELLI
Entity type:Organization
Organization Name:BACK AND NECK CARE CENTERS OF DRS FRIDAY & MANGANELLI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-544-7074
Mailing Address - Street 1:7 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2829
Mailing Address - Country:US
Mailing Address - Phone:410-544-7074
Mailing Address - Fax:410-544-3983
Practice Address - Street 1:7 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2829
Practice Address - Country:US
Practice Address - Phone:410-544-7074
Practice Address - Fax:410-544-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1335PT111N00000X
MD1347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE492OtherBCBS
MDW3780002OtherBCBS FED
MDE491OtherBCBS
MDW3780001OtherBCBS FED
MD857LMedicare ID - Type Unspecified
MDW3780002OtherBCBS FED
T59467Medicare UPIN