Healthcare Provider Details

I. General information

NPI: 1760460158
Provider Name (Legal Business Name): JASON VAUGHN WALP DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8913 CLEMENT AVE
PARKVILLE MD
21234-2603
US

IV. Provider business mailing address

8913 CLEMENT AVE
PARKVILLE MD
21234-2603
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-6500
  • Fax: 410-882-6640
Mailing address:
  • Phone: 410-882-6500
  • Fax: 410-882-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS02184
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: