Provider Demographics
NPI:1316187818
Name:BETTER LIFE CHIROPRACTIC & REHABILITATION CENTER
Entity Type:Organization
Organization Name:BETTER LIFE CHIROPRACTIC & REHABILITATION CENTER
Other - Org Name:SKOCIK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:R
Authorized Official - Last Name:SKOCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-734-2225
Mailing Address - Street 1:1111 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6903
Mailing Address - Country:US
Mailing Address - Phone:302-734-2225
Mailing Address - Fax:
Practice Address - Street 1:1111 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6903
Practice Address - Country:US
Practice Address - Phone:302-734-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000724111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE197246Medicare PIN