Provider Demographics
NPI:1356486450
Name:DEMAIO, JOHN VICTOR (D,C,)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VICTOR
Last Name:DEMAIO
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 BRANDERMILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1985
Mailing Address - Country:US
Mailing Address - Phone:410-721-2222
Mailing Address - Fax:410-721-2437
Practice Address - Street 1:2391 BRANDERMILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1985
Practice Address - Country:US
Practice Address - Phone:410-721-2222
Practice Address - Fax:410-721-2437
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01522111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU19303Medicare UPIN
MD159QMedicare ID - Type Unspecified