Provider Demographics
NPI:1518186410
Name:MUFAREH, JOSEPH JACOB (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JACOB
Last Name:MUFAREH
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1602
Mailing Address - Country:US
Mailing Address - Phone:410-248-1220
Mailing Address - Fax:
Practice Address - Street 1:9115 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1602
Practice Address - Country:US
Practice Address - Phone:410-248-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO2170111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD897BOtherCAREFIRST
DCLU29OtherCAREFIRST
MD64577201OtherCAREFIRST RENDERING #
MD171P403GMedicare ID - Type Unspecified
DCLU29OtherCAREFIRST