Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111NS0005X | Chiropractor | Sports Physician | 1542 PT | MARYLAND | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1623373 | OTHER | MARYLAND | UHC PROVIDER ID |
| 2 | 5856209 | OTHER | MARYLAND | AETNA PROVIDER ID |
| 3 | LP84AN | OTHER | MARYLAND | CAREFIRST BCBS PROV. ID |
| 4 | 086650000 | OTHER | MARYLAND | PREF HEALTH NET PROV. ID |
| 5 | 292468 | OTHER | MARYLAND | ALLIANCE PROVIDER ID |
| 6 | R6170002 | OTHER | MARYLAND | FEDERAL BCBS PROV. ID |
| 7 | ========= | OTHER | MARYLAND | TAX ID NUMBER |
| 8 | 293065600 | OTHER | MARYLAND | US DEPT LABOR PROV. ID |
| 9 | 6074299 | OTHER | MARYLAND | CIGNA PROVIDER ID |
| 10 | U27466 | MEDICARE UPIN | MARYLAND | |
| 11 | 913L 355E | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | MEDICARE PROVIDER ID |
| 12 | 913L | MEDICARE PIN | MARYLAND | |
