Provider Demographics
NPI:1710090931
Name:TROLLEY SQUARE CHIROPRACTIC
Entity Type:Organization
Organization Name:TROLLEY SQUARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUINNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-425-4440
Mailing Address - Street 1:1308 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4740
Mailing Address - Country:US
Mailing Address - Phone:302-425-4440
Mailing Address - Fax:302-425-4440
Practice Address - Street 1:1308 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4740
Practice Address - Country:US
Practice Address - Phone:302-425-4440
Practice Address - Fax:302-425-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00F87T25Medicare ID - Type Unspecified
DEU72280Medicare UPIN
DEG00125Medicare ID - Type Unspecified