Provider Demographics
NPI:1083737944
Name:MUNESES, TRICIA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:ELIZABETH
Last Name:MUNESES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7389 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3228
Mailing Address - Country:US
Mailing Address - Phone:410-355-7725
Mailing Address - Fax:410-355-4084
Practice Address - Street 1:3721 POTEE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1717
Practice Address - Country:US
Practice Address - Phone:410-355-7725
Practice Address - Fax:410-355-4084
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD883QMedicare ID - Type UnspecifiedPROVIDER #