Provider Demographics
NPI:1386839108
Name:SAMPSON CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:SAMPSON CHIROPRACTIC, PA
Other - Org Name:FAMILY CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-213-0900
Mailing Address - Street 1:12217 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9535
Mailing Address - Country:US
Mailing Address - Phone:410-213-0900
Mailing Address - Fax:410-213-7768
Practice Address - Street 1:12217 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9535
Practice Address - Country:US
Practice Address - Phone:410-213-0900
Practice Address - Fax:410-213-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ645OtherBCBS
MDJ645OtherBCBS