Provider Demographics
NPI:1518218759
Name:PENINSULA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:PENINSULA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-629-4344
Mailing Address - Street 1:26685 SUSSEX HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-8525
Mailing Address - Country:US
Mailing Address - Phone:302-629-4344
Mailing Address - Fax:302-629-4646
Practice Address - Street 1:26685 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-8525
Practice Address - Country:US
Practice Address - Phone:302-629-4344
Practice Address - Fax:302-629-4646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENINSULA CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000189111N00000X
DEF10000807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1023217460Medicare NSC
DE1841519337Medicare NSC