Healthcare Provider Details

I. General information

NPI: 1487726436
Provider Name (Legal Business Name): YALICH CLINIC OF SALISBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 MT HERMON ROAD YALICH CLINIC OF SALISBURY
SALISBURY MD
21804
US

IV. Provider business mailing address

1319 MT HERMON ROAD YALICH CLINIC OF SALISBURY
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-1500
  • Fax: 410-548-1614
Mailing address:
  • Phone: 410-548-1500
  • Fax: 410-548-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01397
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LAWRENCE GRANT SR.
Title or Position: OWNER
Credential: DC
Phone: 410-548-1500