Provider Demographics
NPI:1396825477
Name:ADOLPH, JOHN MITCHELL (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MITCHELL
Last Name:ADOLPH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 BELAIR RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2425
Mailing Address - Country:US
Mailing Address - Phone:410-256-9650
Mailing Address - Fax:410-256-3339
Practice Address - Street 1:8817 BELAIR RD
Practice Address - Street 2:SUITE101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2425
Practice Address - Country:US
Practice Address - Phone:410-256-9650
Practice Address - Fax:410-256-3339
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59521Medicare UPIN
MDM009Medicare ID - Type Unspecified