Individual
JEA SUB SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3460 ELLICOTT CENTER DR STE 102, ELLICOTT CITY, MD 21043
(410) 465-3074
Mailing address
10414 BRADDOCK RUN RD, MIDDLE RIVER, MD 21220-1931
(443) 301-3191
(410) 220-0661
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
S03824
MD
171100000X
Acupuncturist
U02569
MD
Other
Enumeration date
06/24/2015
Last updated
01/04/2019
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