Provider Demographics
NPI:1881804011
Name:MONTGOMERY FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MONTGOMERY FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:HAENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-540-5300
Mailing Address - Street 1:19785 CRYSTAL ROCK DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:301-540-5300
Mailing Address - Fax:301-540-5344
Practice Address - Street 1:19785 CRYSTAL ROCK DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:301-540-5300
Practice Address - Fax:301-540-5344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY FAMILY CHIROPRACTIC LLC NORMAN M HAENDLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD588822700Medicaid
MD722589Medicare PIN
MD722589Medicare ID - Type Unspecified
MD665800800Medicaid