Provider Demographics
NPI:1093011611
Name:HARLEY, NDIDI I (DC)
Entity Type:Individual
Prefix:DR
First Name:NDIDI
Middle Name:I
Last Name:HARLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15309 LITTLETON PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9053
Mailing Address - Country:US
Mailing Address - Phone:202-630-4155
Mailing Address - Fax:
Practice Address - Street 1:1641 RT 3 NORTH
Practice Address - Street 2:SUITE 203
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114
Practice Address - Country:US
Practice Address - Phone:202-630-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030097111N00000X
VA0104556821111N00000X
MDS03843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor