Provider Demographics
NPI:1457885121
Name:M -C- CHIROPRACTIC CLINIC & REHAB CENTER
Entity Type:Organization
Organization Name:M -C- CHIROPRACTIC CLINIC & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-715-5035
Mailing Address - Street 1:8686 ANGEL LN APT 104
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2634
Mailing Address - Country:US
Mailing Address - Phone:302-715-5035
Mailing Address - Fax:302-715-5146
Practice Address - Street 1:911 S DUPONT HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4468
Practice Address - Country:US
Practice Address - Phone:302-715-5035
Practice Address - Fax:302-715-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty