Provider Demographics
NPI:1982785127
Name:WOODBINE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WOODBINE CHIROPRACTIC PC
Other - Org Name:WOODBINE CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANKERANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-489-9841
Mailing Address - Street 1:710 LISBON CENTER DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8629
Mailing Address - Country:US
Mailing Address - Phone:301-489-9841
Mailing Address - Fax:301-624-5731
Practice Address - Street 1:710 LISBON CENTER DR
Practice Address - Street 2:SUITE H
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8629
Practice Address - Country:US
Practice Address - Phone:301-489-9841
Practice Address - Fax:301-624-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG903OtherCAREFIRST DC
MDKEF3OtherCAREFIRST MD
MD539MMedicare ID - Type Unspecified