Provider Demographics
NPI:1538437314
Name:ROCKVILLE MEDICAL AND DISC CENTER LLC
Entity type:Organization
Organization Name:ROCKVILLE MEDICAL AND DISC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-770-1818
Mailing Address - Street 1:5912 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4823
Mailing Address - Country:US
Mailing Address - Phone:301-770-1818
Mailing Address - Fax:301-576-7736
Practice Address - Street 1:5912 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4823
Practice Address - Country:US
Practice Address - Phone:301-770-1818
Practice Address - Fax:301-576-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD176127YDDEMedicare PIN
MD018017YDDEMedicare PIN
MD490369YDDEMedicare PIN
MD215748YDDEMedicare PIN