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General NPI Number Information
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NPI Number | 1669539466
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CHIROPRACTIC & REHABILITATION, P.A.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 850 NEW BURTON RD SUITE 102
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City | DOVER
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State | DE
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Zip | 19904
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Country | US
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Telephone | 302-730-1101
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Fax | 302-730-1103
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Provider Business Mailing Address
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Address Line | 850 NEW BURTON RD SUITE 102
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City | DOVER
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State | DE
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Zip | 19904
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Country | US
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Telephone | 302-730-1101
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Fax | 302-730-1103
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL A GONDOLFO
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Credential | D.C.
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Telephone | 302-730-1101
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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 | 1997113659
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License Number State | DE
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