NPIMap

Organization Active NPI

Life Clinic of MD PC

  • Chiropractor
  • Gaithersburg, MD
National Provider Identifier
1396310082
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
LIFE CLINIC OF MD PC
Practice address
10121 Washingtonian Blvd
Gaithersburg, MD 20878-7398
Phone
(952) 229-7464
NPI assigned
May 25, 2021
Last updated
May 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Reza AlizadehNPI 1538214598
Title
President
Phone
(612) 868-6894

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
Physical Therapy Clinic/Center 261QP2000X
Chiropractor 111N00000X Primary

Addresses

Primary practice location

10121 Washingtonian Blvd
Gaithersburg, MD 20878-7398

Mailing address

PO Box 549
Chanhassen, MN 55317-0549

National Provider Directory

National Provider Directory

Locations

10121 Washingtonian Blvd
Gaithersburg, MD 20878
Phone (301) 569-5171

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1396310082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553170549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10121 WASHINGTONIAN BLVD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208787398",
            "telephone_number": "952-229-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC OF MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "ALIZADEH",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-868-6894"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.