Provider Demographics
NPI:1326187816
Name:BAYVIEW CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BAYVIEW CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WELLINGTON
Authorized Official - Middle Name:SIMMONS
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:302-378-2273
Mailing Address - Street 1:104 MIDDESSA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-6819
Mailing Address - Country:US
Mailing Address - Phone:302-378-2273
Mailing Address - Fax:302-378-1183
Practice Address - Street 1:104 MIDDESSA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-6819
Practice Address - Country:US
Practice Address - Phone:302-378-2273
Practice Address - Fax:302-378-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2399337000OtherAMERIHEALTH INDEP BCBS DE
DE=========OtherBCBS
DEG01932B01Medicare PIN
DE=========OtherBCBS