Provider Demographics
NPI:1700554946
Name:DIH CAMP
Entity Type:Organization
Organization Name:DIH CAMP
Other - Org Name:CAMP CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-290-5552
Mailing Address - Street 1:421 E MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1463
Mailing Address - Country:US
Mailing Address - Phone:302-376-5830
Mailing Address - Fax:302-376-6517
Practice Address - Street 1:272 CARTER DR STE 120
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5850
Practice Address - Country:US
Practice Address - Phone:302-378-5110
Practice Address - Fax:302-376-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty