Provider Demographics
NPI:1649900507
Name:NATIONAL CHIROPRACTIC &SPORTS REHABILITATION
Entity type:Organization
Organization Name:NATIONAL CHIROPRACTIC &SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:410-531-8000
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:410-531-8000
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:443-605-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty