Provider Demographics
NPI:1457578361
Name:YALICH, LAWRENCE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:YALICH
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 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-8494
Mailing Address - Fax:410-933-4835
Practice Address - Street 1:9601 PULASKI PARK DR
Practice Address - Street 2:SUITE 416
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-1409
Practice Address - Country:US
Practice Address - Phone:410-933-8494
Practice Address - Fax:410-933-4835
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU61710Medicare UPIN