Provider Demographics
NPI:1700283272
Name:DELAWARE CHIRO & REHAB, INC.
Entity Type:Organization
Organization Name:DELAWARE CHIRO & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANES
Authorized Official - Middle Name:
Authorized Official - Last Name:POLYNICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-455-6804
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-0129
Mailing Address - Country:US
Mailing Address - Phone:302-956-0034
Mailing Address - Fax:302-956-0643
Practice Address - Street 1:100 MARKET ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:DE
Practice Address - Zip Code:19933-1127
Practice Address - Country:US
Practice Address - Phone:302-956-0034
Practice Address - Fax:302-956-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-29
Last Update Date:2014-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20141009154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty