Provider Demographics
NPI:1407035181
Name:NATIONAL CHIROPRACTIC HEALTH & SPORTS REHABILITATION, INC
Entity type:Organization
Organization Name:NATIONAL CHIROPRACTIC HEALTH & SPORTS REHABILITATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-844-1577
Mailing Address - Street 1:8436 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6011
Mailing Address - Country:US
Mailing Address - Phone:410-313-9793
Mailing Address - Fax:410-740-1117
Practice Address - Street 1:5513 TWIN KNOLLS RD STE 219
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3264
Practice Address - Country:US
Practice Address - Phone:410-844-1577
Practice Address - Fax:410-740-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02287Medicare UPIN
MDU11776Medicare UPIN
MDK511Medicare PIN