Healthcare Provider Details

I. General information

NPI: 1740686922
Provider Name (Legal Business Name): MOTIONLIFE CHIROPRACTIC & ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 CENTRE PARK DR STE 208
COLUMBIA MD
21045-2221
US

IV. Provider business mailing address

8808 CENTRE PARK DR STE 208
COLUMBIA MD
21045-2221
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-0987
  • Fax: 410-715-2280
Mailing address:
  • Phone: 410-997-0987
  • Fax: 410-997-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03614
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02139
License Number StateMD

VIII. Authorized Official

Name: DR. SANG MIN LEE
Title or Position: PRESIDENT
Credential: D.C., L.AC.
Phone: 410-997-0987