Healthcare Provider Details

I. General information

NPI: 1942608682
Provider Name (Legal Business Name): SWEETLIFE DIABETES HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34B TROLLEY SQ
WILMINGTON DE
19806-3352
US

IV. Provider business mailing address

34B TROLLEY SQ
WILMINGTON DE
19806-3352
US

V. Phone/Fax

Practice location:
  • Phone: 302-235-3518
  • Fax:
Mailing address:
  • Phone: 302-235-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: BRIAN C MOWLL
Title or Position: OWNER
Credential:
Phone: 302-743-2442