Provider Demographics
NPI:1821014861
Name:SAMUELS, SEAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:A
Last Name:SAMUELS
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 1:2818 CHESWOLDE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3931
Mailing Address - Country:US
Mailing Address - Phone:443-955-3002
Mailing Address - Fax:443-288-4009
Practice Address - Street 1:3701 OLD COURT RD STE 15A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3901
Practice Address - Country:US
Practice Address - Phone:443-660-8177
Practice Address - Fax:443-288-4009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23362111N00000X
MD03495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51350Medicare UPIN
CADC23362Medicare ID - Type Unspecified