Provider Demographics
NPI:1265574495
Name:HAMPDEN FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:HAMPDEN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-420-2381
Mailing Address - Street 1:3914 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1834
Mailing Address - Country:US
Mailing Address - Phone:410-662-4476
Mailing Address - Fax:410-879-9015
Practice Address - Street 1:3914 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1834
Practice Address - Country:US
Practice Address - Phone:410-662-4476
Practice Address - Fax:410-879-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03508111N00000X
MDS01922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU89228Medicare UPIN
MD254MMedicare PIN