Provider Demographics
NPI:1770061681
Name:CHRISTIANA SPINE CENTER PA
Entity type:Organization
Organization Name:CHRISTIANA SPINE CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-996-9522
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 3302
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 TWIN C LN STE 202
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2159
Practice Address - Country:US
Practice Address - Phone:302-636-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIANA SPINE CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty