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General NPI Number Information
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NPI Number | 1669160966
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Entity Type | Individual
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Provider Name | JIMMY VONG DC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 540 E BELVEDERE AVE STE 200
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City | BALTIMORE
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State | MD
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Zip | 21212-3750
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Country | US
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Telephone | 410-323-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 MAPLE CLIFF WAY
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-5531
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Country | US
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Telephone | 716-465-4721
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | S04151
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License Number State | MD
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