Provider Demographics
NPI:1770866378
Name:PURE WELLNESS OF WILMINGTON, LLC
Entity Type:Organization
Organization Name:PURE WELLNESS OF WILMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-365-6520
Mailing Address - Street 1:550 STANTON CHRISTIANA RD STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2132
Mailing Address - Country:US
Mailing Address - Phone:302-365-6520
Mailing Address - Fax:302-365-6167
Practice Address - Street 1:2106 SILVERSIDE RD STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4163
Practice Address - Country:US
Practice Address - Phone:302-365-5470
Practice Address - Fax:302-365-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty