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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