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General NPI Number Information
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NPI Number | 1588947790
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Entity Type | Organization
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Legal Business Name | LOGULLO CHIROPRACTIC WELLNESS CENTER PA
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 600 N BROAD ST STE 19
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1032
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Country | US
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Telephone | 302-378-5441
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N BROAD ST STE 19
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1032
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Country | US
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Telephone | 302-378-5441
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARK LOGULLO
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Credential | D.C.
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Telephone | 302-378-5441
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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 | F1-0000415
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License Number State | DE
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