Provider Demographics
NPI:1487726436
Name:YALICH CLINIC OF SALISBURY
Entity type:Organization
Organization Name:YALICH CLINIC OF SALISBURY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:410-548-1500
Mailing Address - Street 1:1319 MT HERMON ROAD
Mailing Address - Street 2:YALICH CLINIC OF SALISBURY
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-548-1500
Mailing Address - Fax:410-548-1614
Practice Address - Street 1:1319 MT HERMON ROAD
Practice Address - Street 2:YALICH CLINIC OF SALISBURY
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-548-1500
Practice Address - Fax:410-548-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD01397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T93148Medicare UPIN