Provider Demographics
NPI:1801921416
Name:FOUTZ, PAUL L (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:FOUTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 BALDWIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1936
Mailing Address - Country:US
Mailing Address - Phone:410-692-6710
Mailing Address - Fax:410-557-0059
Practice Address - Street 1:1117 BALDWIN MILL RD
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1936
Practice Address - Country:US
Practice Address - Phone:410-692-6710
Practice Address - Fax:410-557-0059
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01547111NR0400X
MDS01547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52328601OtherBCBS RENDERING PROVIDER
MDU27884Medicare UPIN
MD183790Medicare PIN
MD00M247Medicare PIN