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 | 111N00000X | Chiropractor | | S01678 | 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 | 1141701 | OTHER | | ANOTHER AETNA # |
| 2 | K4510001 | OTHER | DISTRICT OF COLUMBIA | BCBS FOR WASH DC |
| 3 | 1551638 | OTHER | | FIRST HEALTH INS |
| 4 | 325540 | OTHER | | PHCS INS. # |
| 5 | 7365788 | OTHER | | AETNA OTHER #'S |
| 6 | K4510001 | OTHER | | BCBS FEDERAL |
| 7 | S01678 | OTHER | MARYLAND | CHIROPRACTIC LICENSE |
| 8 | 219Q | MEDICARE ID-TYPE UNSPECIFIED | | |
| 9 | 1323843 | OTHER | | AETNA |
| 10 | 763B | OTHER | | MARYLAND BCBS |
| 11 | 730L | MEDICARE ID-TYPE UNSPECIFIED | | FOR HEALTHSOUTH EMPLOYER |
| 12 | 672779 | OTHER | | ACN PROVIDER NUMBER |
| 13 | UO1270 | MEDICARE UPIN | | |
| 14 | 10434460 | OTHER | | CAQH ID NUMBER |
