Healthcare Provider Details

I. General information

NPI: 1174933907
Provider Name (Legal Business Name): DELAWARE SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BECKS WOODS DR SUITE 100
BEAR DE
19701-3854
US

IV. Provider business mailing address

PO BOX 1517
BEAR DE
19701-7517
US

V. Phone/Fax

Practice location:
  • Phone: 302-287-9914
  • Fax: 866-347-3120
Mailing address:
  • Phone: 302-287-9914
  • Fax: 866-347-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: DR. ANDREW MARK LEITZKE
Title or Position: OWNER
Credential: DC
Phone: 302-287-9914