Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S03986 | MD |
NPI | 1003388372 |
---|---|
Provider Name | Dr. Elliott Poehlman |
First Address | Catonsville, MD 21228-4858 |
Second Address | Baltimore, MD 21228-4858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2018 |
Last Update Date | 26/12/2018 |