Healthcare Provider Details

I. General information

NPI: 1679040877
Provider Name (Legal Business Name): WOW CHIROPRACTIC CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 YORK RD STE 302
LUTHERVILLE MD
21093-6054
US

IV. Provider business mailing address

1407 YORK RD STE 302
LUTHERVILLE MD
21093-6054
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-5654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EUNDAE SHUGG
Title or Position: DIRECTOR
Credential: DC
Phone: 410-583-5654