Healthcare Provider Details

I. General information

NPI: 1043916596
Provider Name (Legal Business Name): WOW CHIROPRACTIC CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 DORSEY RD STE 104
HANOVER MD
21076-1188
US

IV. Provider business mailing address

1741 DORSEY RD STE 104
HANOVER MD
21076-1188
US

V. Phone/Fax

Practice location:
  • Phone: 410-774-9870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: EUNDAE SUK
Title or Position: DIRECTOR
Credential:
Phone: 410-774-9870