Provider Demographics
NPI:1427391614
Name:BRANDYWINE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BRANDYWINE HEALTH AND WELLNESS LLC
Other - Org Name:FIRST STATE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
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:302-454-1230
Mailing Address - Street 1:1536 KIRKWOOD HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5716
Mailing Address - Country:US
Mailing Address - Phone:302-454-1230
Mailing Address - Fax:302-454-5855
Practice Address - Street 1:2036 FOULK ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3648
Practice Address - Country:US
Practice Address - Phone:302-475-4200
Practice Address - Fax:302-475-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000855111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty