Provider Demographics
NPI:1689685539
Name:COHEN, LYDIA MARLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:MARLENE
Last Name:COHEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8805
Mailing Address - Country:US
Mailing Address - Phone:302-239-1600
Mailing Address - Fax:302-239-1919
Practice Address - Street 1:202 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8805
Practice Address - Country:US
Practice Address - Phone:302-239-1600
Practice Address - Fax:302-239-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDEF10000194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC0456845Medicare ID - Type Unspecified
DET26985Medicare UPIN