Healthcare Provider Details

I. General information

NPI: 1427229426
Provider Name (Legal Business Name): PHILIP BRUCE DEMOND D,C,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KIRKWOOD HWY LIBERTY PLAZA STE 4 2ND FLOOR
NEWARK DE
19711-5539
US

IV. Provider business mailing address

109 S GERALD DR
NEWARK DE
19713-3217
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-6477
  • Fax:
Mailing address:
  • Phone: 302-994-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberF1-0000688
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: