Provider Demographics
NPI:1265939722
Name:ABADOM, VICTOR IFEANYI
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:IFEANYI
Last Name:ABADOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1834
Mailing Address - Country:US
Mailing Address - Phone:410-662-4476
Mailing Address - Fax:
Practice Address - Street 1:3914 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1834
Practice Address - Country:US
Practice Address - Phone:443-472-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor