Healthcare Provider Details

I. General information

NPI: 1114223435
Provider Name (Legal Business Name): APEX CHIROPRACTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE STE 120
NEWARK DE
19702-4777
US

IV. Provider business mailing address

2600 GLASGOW AVE STE 120
NEWARK DE
19702-4777
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-8200
  • Fax:
Mailing address:
  • Phone: 302-836-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF10000583
License Number StateDE

VIII. Authorized Official

Name: JUSTIN DIETRICH
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 302-836-8200