Healthcare Provider Details

I. General information

NPI: 1972274629
Provider Name (Legal Business Name): FELICIA LEIPOLD DC, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 OLD ANNAPOLIS RD STE 301
ELLICOTT CITY MD
21042-6337
US

IV. Provider business mailing address

9501 OLD ANNAPOLIS RD STE 301
ELLICOTT CITY MD
21042-6337
US

V. Phone/Fax

Practice location:
  • Phone: 443-605-4221
  • Fax:
Mailing address:
  • Phone: 443-605-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS04104
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: