NPIMap

Organization Active NPI

Ellicott City Wellness Chiropractic, L.L.C.

  • Chiropractor
  • Ellicott City, MD
National Provider Identifier
1063797694
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1468 PT Issued in MD
Legal business name
ELLICOTT CITY WELLNESS CHIROPRACTIC, L.L.C.
Practice address
9025 Chevrolet Dr
Suite D
Ellicott City, MD 21042-4017
Phone
(410) 750-2540
Fax
(410) 750-2541
NPI assigned
Oct 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brian G. Heaton, D.C.NPI 1982734836
Title
Doctor
Phone
(410) 750-2540

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 1467 PT MD
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 1468 PT MD Primary

Addresses

Primary practice location

9025 Chevrolet Dr
Suite D
Ellicott City, MD 21042-4017

Mailing address

9025 Chevrolet Dr
Suite D
Ellicott City, MD 21042-4017
Phone (410) 750-2540

Other identifiers 3

IdentifierTypeStateIssuer
Y921-0001OtherMDCAREFIRST(BRIAN)
Y921-0002OtherMDCAREFIRST(LINDSEY)
Y921OtherMDCAREFIRST(GROUP#)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130218000003 MD Part B Supplier - Clinic/Group Practice 2466606611 Receives reassigned benefits from 2 practitioners
Practice locations: Ellicott City, MD; Townson, MD

National Provider Directory

National Provider Directory

Locations

9025 Chevrolet Dr
Ste D
Ellicott City, MD 21042
Phone (410) 750-2540

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1063797694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9025 CHEVROLET DR",
            "address_2": "SUITE D",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424017",
            "telephone_number": "410-750-2540",
            "fax_number": "410-750-2541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9025 CHEVROLET DR",
            "address_2": "SUITE D",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424017",
            "telephone_number": "410-750-2540",
            "fax_number": "410-750-2541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTT CITY WELLNESS CHIROPRACTIC, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "HEATON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "410-750-2540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "1467 PT",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "1468 PT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST(BRIAN)",
            "identifier": "Y921-0001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST(LINDSEY)",
            "identifier": "Y921-0002",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST(GROUP#)",
            "identifier": "Y921",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.