Healthcare Provider Details

I. General information

NPI: 1356486450
Provider Name (Legal Business Name): JOHN VICTOR DEMAIO D,C,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 BRANDERMILL BLVD STE 105
GAMBRILLS MD
21054-1985
US

IV. Provider business mailing address

2391 BRANDERMILL BLVD STE 105
GAMBRILLS MD
21054-1985
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-2222
  • Fax: 410-721-2437
Mailing address:
  • Phone: 410-721-2222
  • Fax: 410-721-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01522
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberS01522
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: