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Organization
ELLICOTT CITY WELLNESS CHIROPRACTIC, L.L.C.
Active
Organization
ELLICOTT CITY WELLNESS CHIROPRACTIC, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN G. HEATON D.C. (DOCTOR)
(410) 750-2540
Entity
Organization
Contact information
Practice address
9025 CHEVROLET DR, SUITE D, ELLICOTT CITY, MD 21042-4017
(410) 750-2540
(410) 750-2541
Mailing address
9025 CHEVROLET DR, SUITE D, ELLICOTT CITY, MD 21042-4017
(410) 750-2540
(410) 750-2541
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1467 PT
MD
111N00000X
Chiropractor
Primary
1468 PT
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y921
CAREFIRST(GROUP#)
MD
01
—
Y921-0001
CAREFIRST(BRIAN)
MD
01
—
Y921-0002
CAREFIRST(LINDSEY)
MD
Enumeration date
10/14/2011
Last updated
01/28/2013
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