Healthcare Provider Details

I. General information

NPI: 1932445129
Provider Name (Legal Business Name): JOHN L MICHIE DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ADMIRAL COCHRANE DR STE 204
ANNAPOLIS MD
21401-7419
US

IV. Provider business mailing address

175 ADMIRAL COCHRANE DR STE 204
ANNAPOLIS MD
21401-7419
US

V. Phone/Fax

Practice location:
  • Phone: 443-433-0590
  • Fax: 443-433-0591
Mailing address:
  • Phone: 443-433-0590
  • Fax: 443-433-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOHN MICHIE
Title or Position: OWNER
Credential:
Phone: 443-433-0590