Octavia C Prince

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

S03991 Issued in MD

Practice address

6414 Park Heights Ave Ste G1
Baltimore, MD 21215-3064

Phone

(404) 263-1004

NPI assigned

Jun 22, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Zen Chiropractic & Wellness Space

  • Chiropractor
  • Baltimore, MD
  • NPI 1841909900
  Medicare reassignment NPD Authorized official
• Fidel Chiropractic Center, Inc.

  • Rehabilitation Chiropractor
  • Baltimore, MD
  • NPI 1134345101
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1104442573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6414 PARK HEIGHTS AVE STE G1",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212153064",
            "telephone_number": "404-263-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6414 PARK HEIGHTS AVE STE G1",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212153064",
            "telephone_number": "404-263-1004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1866F Reisterstown Rd",
            "address_purpose": "LOCATION",
            "city": "Pikesville",
            "state": "MD",
            "postal_code": "212081335",
            "country_code": "US",
            "telephone_number": "410-413-1152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "OCTAVIA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-22",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S03991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887504900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Prince, D.O.
• Gabrielle Tova Prince, MD
• Jack F Prince, O.D.
• Kelvin Prince Jr.
• Kennedi Prince
• Renee Prince
• Tanya Y Prince, MHS, CAC-AD
• Sharon Principe, MS, CCC-SLP
• Jasmine Pringle, MD
• Kate R.E.J. Prior, MD

• Chiropractor in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Chiropractor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.