Provider Demographics
NPI:1699056010
Name:MICHAEL E BARVINCHACK, DC, PC
Entity type:Organization
Organization Name:MICHAEL E BARVINCHACK, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EVON
Authorized Official - Last Name:BARVINCHACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-714-4929
Mailing Address - Street 1:19426 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1468
Mailing Address - Country:US
Mailing Address - Phone:301-714-4929
Mailing Address - Fax:301-714-1383
Practice Address - Street 1:19426 LEITERSBURG PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1468
Practice Address - Country:US
Practice Address - Phone:301-714-4929
Practice Address - Fax:301-714-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01964261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442RMedicare PIN
U82852Medicare UPIN