Provider Demographics
NPI:1174297386
Name:DELAWARE INTEGRATIVE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:DELAWARE INTEGRATIVE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:421 E MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1463
Mailing Address - Country:US
Mailing Address - Phone:302-376-5830
Mailing Address - Fax:302-376-6517
Practice Address - Street 1:686 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1002
Practice Address - Country:US
Practice Address - Phone:302-503-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty