Provider Demographics
NPI:1053835926
Name:DOVER CHIROPRACTIC AND REHABILITATION, INC.
Entity Type:Organization
Organization Name:DOVER CHIROPRACTIC AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-376-5830
Mailing Address - Street 1:103 ASHVALE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4031
Mailing Address - Country:US
Mailing Address - Phone:302-290-5552
Mailing Address - Fax:302-376-6517
Practice Address - Street 1:222 S DUPONT HWY STE 203
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3798
Practice Address - Country:US
Practice Address - Phone:302-290-5552
Practice Address - Fax:302-376-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000721111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty