Provider Demographics
NPI:1447993217
Name:NWOSU, CHIDIMMA LAQUEEN (DC)
Entity type:Individual
Prefix:
First Name:CHIDIMMA
Middle Name:LAQUEEN
Last Name:NWOSU
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 1:2001 EASTERN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3061
Mailing Address - Country:US
Mailing Address - Phone:443-842-5500
Mailing Address - Fax:
Practice Address - Street 1:2001 EASTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3061
Practice Address - Country:US
Practice Address - Phone:443-842-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty