Provider Demographics
NPI:1902382906
Name:PURE WELLNESS OF MIDDLETOWN, LLC
Entity Type:Organization
Organization Name:PURE WELLNESS OF MIDDLETOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:J
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 1:708 ASH BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8871
Practice Address - Country:US
Practice Address - Phone:302-449-0149
Practice Address - Fax:302-449-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty