Provider Demographics
NPI:1093856106
Name:PODMIJERSKY, SUE ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUE ELLEN
Middle Name:
Last Name:PODMIJERSKY
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 1:4415 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1225
Mailing Address - Country:US
Mailing Address - Phone:410-366-3250
Mailing Address - Fax:410-366-3252
Practice Address - Street 1:4415 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1225
Practice Address - Country:US
Practice Address - Phone:410-366-3250
Practice Address - Fax:410-366-3252
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor