Provider Demographics
NPI:1073646907
Name:DELAWARE INJURY CARE L.L.C.
Entity Type:Organization
Organization Name:DELAWARE INJURY CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-960-1145
Mailing Address - Street 1:4023 KENNETT PIKE # 620
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2018
Mailing Address - Country:US
Mailing Address - Phone:914-960-1145
Mailing Address - Fax:866-378-9982
Practice Address - Street 1:240 BEISER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8208
Practice Address - Country:US
Practice Address - Phone:302-678-8866
Practice Address - Fax:866-378-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty