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Individual

DR. THEODORE W TABER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
14300 GALLANT FOX LN, SUITE 201, BOWIE, MD 20715-4003
(301) 352-4500
(301) 352-6510
Mailing address
14300 GALLANT FOX LN, SUITE 201, BOWIE, MD 20715-4003
(301) 352-4500
(301) 352-6510

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
S01943
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
287087
MAMSI PROVIDER NUMBER
MD
01
522247005
FEDERAL TAX ID
01
60608903
CAREFIRST BCBS OF MD REG#
MD
01
LR25TA
CAREFIRST BCBS OF MD
MD
01
S2410002
CAREFIRST BC/BS
DC
Enumeration date
08/09/2005
Last updated
05/14/2010
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