Healthcare Provider Details

I. General information

NPI: 1932679404
Provider Name (Legal Business Name): DELAWARE HEALTHCARE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 N KING ST
WILMINGTON DE
19801-3220
US

IV. Provider business mailing address

14 CHASEMOUNT CT
BALTIMORE MD
21209-1053
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-7834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: ALLA TALIS
Title or Position: MEMBER
Credential:
Phone: 443-739-7834