NPIMap

Organization Active NPI

Howard County Chiropractic Spine & Sports Rehabilitation. LLC

  • Sports Physician Chiropractor
  • Columbia, MD
National Provider Identifier
1801011895
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
S01939 Issued in MD
Legal business name
HOWARD COUNTY CHIROPRACTIC SPINE & SPORTS REHABILITATION. LLC
Practice address
8894 Stanford Blvd
Suite I02
Columbia, MD 21045-4794
Phone
(443) 259-0235
Fax
(443) 259-0236
NPI assigned
Apr 16, 2007
Last updated
Jan 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Authorized official

Name
Dr. Russel Vincent Antico, D.C., CCSPNPI 1619048576
Title
Owner
Phone
(443) 259-0235

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NS0005X S01939 MD Primary

Addresses

Primary practice location

8894 Stanford Blvd
Suite I02
Columbia, MD 21045-4794

Mailing address

8894 Stanford Blvd
Suite I02
Columbia, MD 21045-4794
Phone (443) 259-0235

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080424000387 MD Part B Supplier - Clinic/Group Practice 9234217753 Receives reassigned benefits from 3 practitioners
Practice locations: Columbia, MD

National Provider Directory

National Provider Directory

Locations

7060 Oakland Mills Rd
Ste I
Columbia, MD 21046
Phone (443) 259-0235

8894 Stanford Blvd
Ste I2
Columbia, MD 21045
Phone (443) 259-0235

Practitioners & affiliated clinicians

Practitioners 4

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": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1801011895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8894 STANFORD BLVD",
            "address_2": "SUITE I02",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454794",
            "telephone_number": "443-259-0235",
            "fax_number": "443-259-0236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8894 STANFORD BLVD",
            "address_2": "SUITE I02",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454794",
            "telephone_number": "443-259-0235",
            "fax_number": "443-259-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOWARD COUNTY CHIROPRACTIC SPINE & SPORTS REHABILITATION. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "ANTICO",
        "authorized_official_first_name": "RUSSEL",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-259-0235",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., CCSP"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "MD",
            "license": "S01939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.