Healthcare Provider Details

I. General information

NPI: 1568032027
Provider Name (Legal Business Name): DELAWARE INTEGRATIVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
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

421 E MAIN ST STE 6
MIDDLETOWN DE
19709-1463
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-8650
  • Fax: 302-744-8983
Mailing address:
  • Phone: 302-376-5830
  • Fax: 302-376-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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