=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053517334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINCIGUERRA FAMILY CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2007
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 GRUBB RD STE 132
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-4711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-475-3200
-----------------------------------------------------
Fax | 302-475-2516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 GRUBB RD STE 132
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-4711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-475-3200
-----------------------------------------------------
Fax | 302-475-2516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CATHERINE PORRINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-475-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | F1-280
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------