Provider Demographics
NPI:1275649030
Name:WILMINGTON CHIROPRACTIC HEALTH CENTER LLC
Entity Type:Organization
Organization Name:WILMINGTON CHIROPRACTIC HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-454-1200
Mailing Address - Street 1:1536 KIRKWOOD HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-575-8330
Mailing Address - Fax:302-575-8321
Practice Address - Street 1:910 N UNION ST STE 3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-5334
Practice Address - Country:US
Practice Address - Phone:302-454-1230
Practice Address - Fax:302-454-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2004211645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01808Medicare PIN