South River Family Chiropractic Llc | |
3168 Braverton St Ste 302 Edgewater MD 21037-2680 | |
(410) 353-1616 | |
Not Available |
Full Name | South River Family Chiropractic Llc |
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Speciality | Clinic/Center |
Location | 3168 Braverton St Ste 302, Edgewater, Maryland |
Authorized Official Name and Position | Angela Carlynn Tarjick (OWNER/CHIROPRACTOR) |
Authorized Official Contact | 4103531616 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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South River Family Chiropractic Llc 1406 James Way Edgewater MD 21037-1713 Ph: (410) 353-1616 | South River Family Chiropractic Llc 3168 Braverton St Ste 302 Edgewater MD 21037-2680 Ph: (410) 353-1616 |
NPI Number | 1528709128 |
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Provider Enumeration Date | 04/06/2022 |
Last Update Date | 04/06/2022 |
Medicare PECOS PAC ID | 4688054075 |
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Medicare Enrollment ID | O20220701000372 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528709128 | NPI | - | NPPES |
1932344272 | Other | PROVIDER NPI |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Angela Carlynn Tarjick |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1932344272 PECOS PAC ID: 0143384453 Enrollment ID: I20090202000277 |
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