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 | 293065600 | OTHER | MARYLAND | US DEPT LABOR PROV. ID |
| 2 | 521737601 | OTHER | MARYLAND | TAX ID NUMBER |
| 3 | R6170002 | OTHER | MARYLAND | FEDERAL BCBS PROV. ID |
| 4 | 292468 | OTHER | MARYLAND | ALLIANCE PROIDER ID |
| 5 | 086650000 | OTHER | MARYLAND | PREF HEALTH NET PROV. ID |
| 6 | 1623373 | OTHER | MARYLAND | UHC PROVIDER ID |
| 7 | U27466 | MEDICARE UPIN | MARYLAND | |
| 8 | 5856209 | OTHER | MARYLAND | AETNA PROVIDER ID |
| 9 | 6074299 | OTHER | MARYLAND | CIGNA PROVIDER ID |
| 10 | LP84AN | OTHER | MARYLAND | CAREFIRST BCBS PROV. ID |
| 11 | 913L 355E | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | MEDICARE PROVIDER ID |
