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General NPI Number Information
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NPI Number | 1699715276
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Entity Type | Individual
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Provider Name | DARRIS E. WINE D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 905 S HIGH ST
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City | WEST CHESTER
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State | PA
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Zip | 19382-5416
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Country | US
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Telephone | 610-429-3240
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Fax | 610-429-3240
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Provider Business Mailing Address
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Address Line | 905 S HIGH ST
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City | WEST CHESTER
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State | PA
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Zip | 19382-5416
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Country | US
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Telephone | 610-429-3240
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Fax | 610-429-3240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | DC-003556
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License Number State | PA
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