Provider Demographics
NPI:1659646867
Name:WISE, ERICA J (DC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:WISE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:J
Other - Last Name:URRUTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6810 PARK HEIGHTS AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1662
Mailing Address - Country:US
Mailing Address - Phone:443-842-5500
Mailing Address - Fax:667-309-6024
Practice Address - Street 1:2001 EASTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3061
Practice Address - Country:US
Practice Address - Phone:443-842-5500
Practice Address - Fax:443-842-5501
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor