Provider Demographics
NPI:1548323447
Name:KLINGLER, AUDIE GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:AUDIE
Middle Name:GEORGE
Last Name:KLINGLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2877
Mailing Address - Country:US
Mailing Address - Phone:301-777-0110
Mailing Address - Fax:301-722-2982
Practice Address - Street 1:203 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2877
Practice Address - Country:US
Practice Address - Phone:301-777-0110
Practice Address - Fax:301-722-2982
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5669650001Medicare NSC
MDT59572Medicare UPIN