Healthcare Provider Details

I. General information

NPI: 1306439492
Provider Name (Legal Business Name): ANTOINE JERRELL WRIGHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANTOINE JERRELL WRIGHT DR.WRIGHT

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 F REISTERSTOWN RD
PIKESVILLE MD
21208
US

IV. Provider business mailing address

1866 F REISTERSTOWN RD
PIKESVILLE MD
21208
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-5642
  • Fax: 410-484-5541
Mailing address:
  • Phone: 410-484-5642
  • Fax: 410-484-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS04072
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS04072
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: