Provider Demographics
NPI:1558451278
Name:BLUE HEN CHIROPRACTIC & WELLNESS, PA
Entity Type:Organization
Organization Name:BLUE HEN CHIROPRACTIC & WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-369-2940
Mailing Address - Street 1:421 NEW LONDON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7009
Mailing Address - Country:US
Mailing Address - Phone:302-369-2940
Mailing Address - Fax:302-369-2949
Practice Address - Street 1:421 NEW LONDON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7009
Practice Address - Country:US
Practice Address - Phone:302-369-2940
Practice Address - Fax:302-369-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00862Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER