Provider Demographics
NPI:1912075128
Name:HYLAND ROBERTSON, THOMAS KENNY (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENNY
Last Name:HYLAND ROBERTSON
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 1:1202 ANNAPOLIS RD
Mailing Address - Street 2:SUITE I, 2ND FLR
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1397
Mailing Address - Country:US
Mailing Address - Phone:410-305-1331
Mailing Address - Fax:480-393-5959
Practice Address - Street 1:1202 ANNAPOLIS RD
Practice Address - Street 2:SUITE I, 2ND FLR
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1397
Practice Address - Country:US
Practice Address - Phone:410-305-1331
Practice Address - Fax:480-393-5959
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV00133Medicare UPIN