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Organization
NORTH EAST CHIROPRACTIC PA
Active
Organization
NORTH EAST CHIROPRACTIC PA
Active
Other names
Blackiston Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEATHER MCCOY BLACKISTON D.C. (OWNER)
(410) 642-9110
Entity
Organization
Contact information
Practice address
2316 PULASKI HWY STE B, NORTH EAST, MD 21901-3730
(410) 642-9110
(410) 642-9113
Mailing address
2316 PULASKI HWY STE B, NORTH EAST, MD 21901-3730
(410) 642-9110
(410) 642-9113
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
02079
MD
225100000X
Physical Therapist
02079
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2912304
AETNA PROV. ID
MD
01
—
61670301
BC RENDERING PROV. ID
MD
Enumeration date
04/16/2007
Last updated
03/16/2021
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