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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