Provider Demographics
NPI:1427119296
Name:CAMBRIDGE CHIROPRACTIC CENTER, P.A
Entity type:Organization
Organization Name:CAMBRIDGE CHIROPRACTIC CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-221-0781
Mailing Address - Street 1:421 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1927
Mailing Address - Country:US
Mailing Address - Phone:410-221-0781
Mailing Address - Fax:410-476-3400
Practice Address - Street 1:421 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1927
Practice Address - Country:US
Practice Address - Phone:410-221-0781
Practice Address - Fax:410-476-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD004731111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKL70HY13Medicare PIN
MDU42233Medicare UPIN