Annapolis Back & Neck Center, LLC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

S01457 Issued in MD

Legal business name

ANNAPOLIS BACK & NECK CENTER, LLC

Practice address

914 Bay Ridge Rd Ste 150
Annapolis, MD 21403-3953

Phone

(410) 267-0033

Fax

(410) 267-0444

NPI assigned

Mar 8, 2012

Last updated

Mar 8, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James Michael Wagner, D.C.NPI 1083791818

Title

Owner

Phone

(410) 267-0033

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James M Wagner, D.C.

  • Sports Physician Chiropractor
  • Annapolis, MD
  • NPI 1083791818
  Medicare reassignment NPD Authorized official
• Jonathan R. Holtzman, D.C.

  • Chiropractor
  • Annapolis, MD
  • NPI 1255313037
  NPD (past)

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

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331164800000",
    "number": "1164796181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 BAY RIDGE RD STE 150",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214033953",
            "telephone_number": "410-267-0033",
            "fax_number": "410-267-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 BAY RIDGE RD STE 150",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214033953",
            "telephone_number": "410-267-0033",
            "fax_number": "410-267-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNAPOLIS BACK & NECK CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-08",
        "last_updated": "2012-03-08",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-267-0033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "MD",
            "license": "S01457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M155",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEP",
            "identifier": "W2090001",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Sports Physician Chiropractor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.