Provider Demographics
NPI:1669866364
Name:DOVER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:DOVER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-531-1900
Mailing Address - Street 1:120 OLD CAMDEN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-5523
Mailing Address - Country:US
Mailing Address - Phone:302-531-1900
Mailing Address - Fax:302-531-1901
Practice Address - Street 1:120 OLD CAMDEN RD
Practice Address - Street 2:SUITE C
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-5523
Practice Address - Country:US
Practice Address - Phone:302-531-1900
Practice Address - Fax:302-531-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01912Medicare UPIN