Healthcare Provider Details

I. General information

NPI: 1275513368
Provider Name (Legal Business Name): THE BACK CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/10/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 KIRKWOOD HWY
WILMINGTON DE
19808-5002
US

IV. Provider business mailing address

5550 KIRKWOOD HWY
WILMINGTON DE
19808-5002
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-2100
  • Fax: 302-998-3104
Mailing address:
  • Phone: 302-995-2100
  • Fax: 302-998-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MELLISSA HIGGINS
Title or Position: OWNER/DIRECTOR
Credential: DPT
Phone: 302-995-2100