Provider Demographics
NPI:1093972796
Name:DELMARVA HEALTH CENTRE, INC
Entity Type:Organization
Organization Name:DELMARVA HEALTH CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-846-9547
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-0369
Mailing Address - Country:US
Mailing Address - Phone:302-846-9547
Mailing Address - Fax:302-846-0516
Practice Address - Street 1:10955 STATE STREET
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-0369
Practice Address - Country:US
Practice Address - Phone:302-846-9547
Practice Address - Fax:302-846-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE031534Medicare PIN