Healthcare Provider Details

I. General information

NPI: 1053835926
Provider Name (Legal Business Name): DOVER CHIROPRACTIC AND REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S DUPONT HWY STE 203
DOVER DE
19901-3798
US

IV. Provider business mailing address

103 ASHVALE DR
SMYRNA DE
19977-4031
US

V. Phone/Fax

Practice location:
  • Phone: 302-290-5552
  • Fax: 302-376-6517
Mailing address:
  • Phone: 302-290-5552
  • Fax: 302-376-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberF1-0000721
License Number StateDE

VIII. Authorized Official

Name: DR. TREVOR KENT ENNIS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 302-376-5830