Healthcare Provider Details

I. General information

NPI: 1700086139
Provider Name (Legal Business Name): CHIROPRACTIC WELLNESS CENTER OF BALTIMORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8723 BELAIR RD
BALTIMORE MD
21236-2419
US

IV. Provider business mailing address

8723 BELAIR RD
BALTIMORE MD
21236-2419
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-8010
  • Fax: 410-529-8424
Mailing address:
  • Phone: 410-529-8010
  • Fax: 410-529-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number02080
License Number StateMD

VIII. Authorized Official

Name: DR. JAMES ANDREW ROEDER
Title or Position: OWNER
Credential: DC
Phone: 410-529-8010