Provider Demographics
NPI:1073965281
Name:ESSEX MEDICAL CENTER
Entity Type:Organization
Organization Name:ESSEX MEDICAL CENTER
Other - Org Name:SLADE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-276-9222
Mailing Address - Street 1:406 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6714
Mailing Address - Country:US
Mailing Address - Phone:410-276-9222
Mailing Address - Fax:
Practice Address - Street 1:3401 ERDMAN AVE
Practice Address - Street 2:A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1956
Practice Address - Country:US
Practice Address - Phone:410-276-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty