Healthcare Provider Details

I. General information

NPI: 1639564594
Provider Name (Legal Business Name): 8TH AND MARKET SPINAL PAIN CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N MARKET ST
WILMINGTON DE
19801-4935
US

IV. Provider business mailing address

727 N MARKET ST
WILMINGTON DE
19801-4935
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-6000
  • Fax:
Mailing address:
  • Phone: 302-652-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF10000903
License Number StatePA

VIII. Authorized Official

Name: DR. BRADLEY BEYER
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 302-652-6000