Provider Demographics
NPI:1235122086
Name:PASADENA NECK AND BACK PAIN CENTER LLC
Entity type:Organization
Organization Name:PASADENA NECK AND BACK PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-360-0014
Mailing Address - Street 1:8096 EDWIN RAYNOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6837
Mailing Address - Country:US
Mailing Address - Phone:410-360-0014
Mailing Address - Fax:410-360-0064
Practice Address - Street 1:8096 EDWIN RAYNOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6837
Practice Address - Country:US
Practice Address - Phone:410-360-0014
Practice Address - Fax:410-360-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKE24PAOtherBCBS MD
MD2184080OtherAETNA
DCT773OtherBCBS OF DC
MD353259OtherMAMSI
MD629389OtherACN
MDKE24PAOtherBCBS MD
U71559Medicare UPIN