Healthcare Provider Details

I. General information

NPI: 1174382956
Provider Name (Legal Business Name): 302 CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SAVANNAH RD
LEWES DE
19958-1525
US

IV. Provider business mailing address

PO BOX 68
WOODSIDE DE
19980-0068
US

V. Phone/Fax

Practice location:
  • Phone: 302-747-6262
  • Fax: 302-736-0380
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MEGAN EPPS
Title or Position: OWNER
Credential: DC
Phone: 302-747-6262