Provider Demographics
NPI:1538360128
Name:KROLL CHIROPRACTIC
Entity type:Organization
Organization Name:KROLL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:VINTON
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-689-1200
Mailing Address - Street 1:1 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1331
Mailing Address - Country:US
Mailing Address - Phone:301-689-1200
Mailing Address - Fax:301-689-1200
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1331
Practice Address - Country:US
Practice Address - Phone:301-689-1200
Practice Address - Fax:301-689-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM589WVOtherBCBS OF MARYLAND, INC.
MD370937OtherMAMSI
MD370937OtherMAMSI
MDU71262Medicare UPIN