Healthcare Provider Details

I. General information

NPI: 1134345101
Provider Name (Legal Business Name): FIDEL CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 REISTERSTOWN RD # F
BALTIMORE MD
21208-1335
US

IV. Provider business mailing address

1866 REISTERSTOWN RD # F
BALTIMORE MD
21208-1335
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-5642
  • Fax: 410-484-5541
Mailing address:
  • Phone: 410-484-5642
  • Fax: 410-484-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1340
License Number StateMD

VIII. Authorized Official

Name: DR. ADAM MARC FIDEL
Title or Position: OWNER
Credential: DC
Phone: 410-484-5642