Provider Demographics
NPI:1437497328
Name:IDEAL HEALTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:IDEAL HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-605-2485
Mailing Address - Street 1:7939 HONEYGO BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7939 HONEYGO BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:314-605-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty