Provider Demographics
NPI:1225578859
Name:MOHEN, SAMANTHA (DC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MOHEN
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 1:6010 MEADOWRIDGE CENTER DR STE K
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6089
Mailing Address - Country:US
Mailing Address - Phone:410-379-8300
Mailing Address - Fax:410-379-0028
Practice Address - Street 1:6010 MEADOWRIDGE CENTER DR STE K
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6089
Practice Address - Country:US
Practice Address - Phone:410-379-8300
Practice Address - Fax:410-379-0028
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor