NPIMap

Organization Active NPI

Gaithersburg Wellness Center

  • Chiropractor
  • Gaithersburg, MD
National Provider Identifier
1750802831
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S03901 Issued in MD
Legal business name
GAITHERSBURG WELLNESS CENTER
Practice address
101 Lakeforest Blvd Ste 395
Gaithersburg, MD 20877-2611
Phone
(919) 402-7551
NPI assigned
Jun 29, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Authorized official

Name
Dr. Sangbum Joo, DCNPI 1336480888
Title
President
Phone
(301) 569-0380

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X S03901 MD Primary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4338 NC
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CH030129 DC

Addresses

Primary practice location

101 Lakeforest Blvd Ste 395
Gaithersburg, MD 20877-2611

Mailing address

101 Lakeforest Blvd Ste 395
Gaithersburg, MD 20877-2746
Phone (301) 200-8060

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170927001081 DC Part B Supplier - Clinic/Group Practice 2961776141 Receives reassigned benefits from 1 practitioner
Practice locations: Gaithersburg, MD

National Provider Directory

National Provider Directory

Locations

101 Lakeforest Blvd
Ste 395
Gaithersburg, MD 20877
Phone (301) 200-8060

Practitioners & affiliated clinicians

Practitioners 1

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": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1750802831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LAKEFOREST BLVD STE 395",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772746",
            "telephone_number": "301-200-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LAKEFOREST BLVD STE 395",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772611",
            "telephone_number": "919-402-7551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAITHERSBURG WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-29",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "JOO",
        "authorized_official_first_name": "SANGBUM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-569-0380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S03901",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4338",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "DC",
            "license": "CH030129",
            "primary": false
        }
    ],
    "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 Dec 15, 2021; 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.