=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144474750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELAWARE CHIROPRACTIC AT TROLLEY SQUARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2008
-----------------------------------------------------
Last Update Date | 07/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26B TROLLEY SQUARE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-777-3431
-----------------------------------------------------
Fax | 302-442-7176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26B TROLLEY SQUARE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-777-3431
-----------------------------------------------------
Fax | 302-442-7176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN C. MOWLL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 302-777-3431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | FL-0000460
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------