Provider Demographics
NPI:1538350624
Name:OPTIMAL SPINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:OPTIMAL SPINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:KORDONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-273-5351
Mailing Address - Street 1:998 HOSPITALITY WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1762
Mailing Address - Country:US
Mailing Address - Phone:410-273-5351
Mailing Address - Fax:
Practice Address - Street 1:998 HOSPITALITY WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1762
Practice Address - Country:US
Practice Address - Phone:410-273-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1316038417OtherNPI