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General NPI Number Information
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NPI Number | 1588104764
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Entity Type | Organization
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Legal Business Name | YALICH CLINIC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 331 OAK MANOR DR
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5548
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Country | US
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Telephone | 410-766-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 CHESTON LN APT E
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City | HANOVER
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State | MD
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Zip | 21076-1410
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Country | US
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Telephone | 567-203-8601
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAM DOUGLAS
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Credential |
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Telephone | 443-749-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 03916
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License Number State | MD
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