Provider Demographics
NPI:1679040877
Name:WOW CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:WOW CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUNDAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-583-5654
Mailing Address - Street 1:1407 YORK RD STE 302
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1407 YORK RD STE 302
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6054
Practice Address - Country:US
Practice Address - Phone:410-583-5654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty