Provider Demographics
NPI:1407918683
Name:PARK PLACE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PARK PLACE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:CHAN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-368-0124
Mailing Address - Street 1:907 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2303
Mailing Address - Country:US
Mailing Address - Phone:302-368-0124
Mailing Address - Fax:302-368-0183
Practice Address - Street 1:907 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2303
Practice Address - Country:US
Practice Address - Phone:302-368-0124
Practice Address - Fax:302-368-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty