Healthcare Provider Details

I. General information

NPI: 1265298087
Provider Name (Legal Business Name): VIM CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 FREDERICK RD STE 2
CATONSVILLE MD
21228-5049
US

IV. Provider business mailing address

1011 FREDERICK RD STE 2
CATONSVILLE MD
21228-5049
US

V. Phone/Fax

Practice location:
  • Phone: 443-636-5824
  • Fax: 443-636-5830
Mailing address:
  • Phone: 443-636-5824
  • Fax: 443-636-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE DAWN KING
Title or Position: OFFICE MANAGER
Credential:
Phone: 443-818-3007