Provider Demographics
NPI:1932285350
Name:SORTISIO, DAVID MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:SORTISIO
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 1:1507 RITCHIE HWY
Mailing Address - Street 2:STE 108
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2743
Mailing Address - Country:US
Mailing Address - Phone:410-349-0000
Mailing Address - Fax:410-349-1782
Practice Address - Street 1:1507 RITCHIE HWY
Practice Address - Street 2:STE 108
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2743
Practice Address - Country:US
Practice Address - Phone:410-349-0000
Practice Address - Fax:410-349-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147027400OtherWORKERS COMPENSATION
MDM14853294701R504001OtherCAREFIRST BCBS
U54052Medicare UPIN
MDM14853294701R504001OtherCAREFIRST BCBS