Provider Demographics
NPI:1821001181
Name:MIDWAY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MIDWAY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-454-1200
Mailing Address - Street 1:1536 CAPITOL TRL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5716
Mailing Address - Country:US
Mailing Address - Phone:302-454-1200
Mailing Address - Fax:302-454-1238
Practice Address - Street 1:18585 COASTAL HIGHWAY
Practice Address - Street 2:UNIT 26
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-9735
Practice Address - Country:US
Practice Address - Phone:302-645-6681
Practice Address - Fax:302-645-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2004200227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01416Medicare PIN