Provider Demographics
NPI:1538286448
Name:SUBURBAN CHIROPRACTIC HEALTH AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:SUBURBAN CHIROPRACTIC HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANGERMAIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-261-6346
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19714-7720
Mailing Address - Country:US
Mailing Address - Phone:302-261-6346
Mailing Address - Fax:302-838-2082
Practice Address - Street 1:1220 PEOPLES PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5701
Practice Address - Country:US
Practice Address - Phone:302-261-6346
Practice Address - Fax:302-838-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE=========Medicare UPIN
DEG02275Medicare ID - Type Unspecified