MEDICARE: THE BALTIMORE BACK PAIN CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	S01182	MD

General Provider Information

NPI Number	:	1124391446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BALTIMORE BACK PAIN CLINIC, INC.

Provider Business Mailing Address
First Line	:	1719 FLEET ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21231-2443
Country	:	US
Telephone Number	:	410-675-3332
Fax Number	:	410-675-3903

Provider Business Practice Location Address
First Line	:	1719 FLEET ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21231-2443
Country	:	US
Telephone Number	:	410-675-3332
Fax Number	:	410-675-3903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH PATRICK HUGHES
Credential	:
Telephone Number	:	410-675-3332

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	09/26/2014

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