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General NPI Number Information
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NPI Number | 1306960927
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Entity Type | Organization
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Legal Business Name | BACK TO INTELLIGENT DESIGN, LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 SOCIETY DR
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City | CLAYMONT
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State | DE
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Zip | 19703-1777
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Country | US
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Telephone | 302-793-1006
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Fax | 302-793-1636
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Provider Business Mailing Address
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Address Line | 1201 SOCIETY DR
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City | CLAYMONT
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State | DE
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Zip | 19703-1777
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Country | US
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Telephone | 302-793-1006
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Fax | 302-793-1636
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Authorized Official
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Title or Position | PARTNER
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Name | DR. PATRICIA ANNE WENDEL
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Credential | DC
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Telephone | 302-793-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | FL-0000557
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License Number State | DE
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