Healthcare Provider Details

I. General information

NPI: 1508262593
Provider Name (Legal Business Name): KIRKWOOD PAIN & INJURY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE FRONT STREET EXT SUITE D
MILFORD DE
19963-1395
US

IV. Provider business mailing address

600 NE FRONT STREET EXT SUITE D
MILFORD DE
19963-1395
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-2329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberF1-0000881
License Number StateDE

VIII. Authorized Official

Name: JEAN LAINE
Title or Position: PRESIDENT
Credential:
Phone: 917-803-3818