Healthcare Provider Details

I. General information

NPI: 1487652202
Provider Name (Legal Business Name): JAHAN D SAMPSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2953 EMMORTON RD
ABINGDON MD
21009-1631
US

IV. Provider business mailing address

9601 PULASKI PARK DR SUITE 416
BALTIMORE MD
21220-1409
US

V. Phone/Fax

Practice location:
  • Phone: 410-515-6785
  • Fax: 410-515-6757
Mailing address:
  • Phone: 410-933-5678
  • Fax: 410-933-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS2070
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: