Provider Demographics
NPI:1619004223
Name:ADOLPH FAMILY CHIROPRACTIC, LLC-PERRY HALL
Entity Type:Organization
Organization Name:ADOLPH FAMILY CHIROPRACTIC, LLC-PERRY HALL
Other - Org Name:SPINALIFE BACK PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-256-9650
Mailing Address - Street 1:8817 BELAIR RD
Mailing Address - Street 2:STE 101
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:STE 101
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01242111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty