Healthcare Provider Details

I. General information

NPI: 1699715276
Provider Name (Legal Business Name): DARRIS E. WINE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S HIGH ST
WEST CHESTER PA
19382-5416
US

IV. Provider business mailing address

905 S HIGH ST
WEST CHESTER PA
19382-5416
US

V. Phone/Fax

Practice location:
  • Phone: 610-429-3240
  • Fax: 610-429-3240
Mailing address:
  • Phone: 610-429-3240
  • Fax: 610-429-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC-003556
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: