Provider Demographics
NPI:1821796327
Name:PATELLIS, SEBASTIAN A (DC)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:A
Last Name:PATELLIS
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 1:2850 N RIDGE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3396
Mailing Address - Country:US
Mailing Address - Phone:410-376-8807
Mailing Address - Fax:
Practice Address - Street 1:2850 N RIDGE RD STE 107
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3396
Practice Address - Country:US
Practice Address - Phone:410-376-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS04171OtherMARYLAND BOARD OF CHIROPRACTIC EXAMINERS