Provider Demographics
NPI:1487050506
Name:ANTHONY, DAMON (DC)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3907
Mailing Address - Country:US
Mailing Address - Phone:301-231-0050
Mailing Address - Fax:301-231-6057
Practice Address - Street 1:6101 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3907
Practice Address - Country:US
Practice Address - Phone:301-231-0050
Practice Address - Fax:301-231-6057
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03799111N00000X
DCCH030122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor