Provider Demographics
NPI:1972274629
Name:LEIPOLD, FELICIA (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:LEIPOLD
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 OLD ANNAPOLIS RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6337
Mailing Address - Country:US
Mailing Address - Phone:443-605-4221
Mailing Address - Fax:
Practice Address - Street 1:9501 OLD ANNAPOLIS RD STE 301
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6337
Practice Address - Country:US
Practice Address - Phone:443-605-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL52072255A2300X
MDS04104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer