Healthcare Provider Details

I. General information

NPI: 1437497328
Provider Name (Legal Business Name): IDEAL HEALTH CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 HONEYGO BLVD SUITE 215
WHITE MARSH MD
21236
US

IV. Provider business mailing address

7939 HONEYGO BLVD SUITE 215
WHITE MARSH MD
21236
US

V. Phone/Fax

Practice location:
  • Phone: 314-605-2485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03500
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ADAM DAVID MADDOX
Title or Position: OWNER
Credential: D.C.
Phone: 314-605-2485