Provider Demographics
NPI:1487652202
Name:SAMPSON, JAHAN D (DC)
Entity type:Individual
Prefix:DR
First Name:JAHAN
Middle Name:D
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:2953 EMMORTON RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1631
Practice Address - Country:US
Practice Address - Phone:410-515-6785
Practice Address - Fax:410-515-6757
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS2070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD614021OtherCAREFIRST
MD10436136OtherCAQH
MD614021OtherCAREFIRST
MDU90063Medicare UPIN