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General NPI Number Information
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NPI Number | 1700283272
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Entity Type | Organization
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Legal Business Name | DELAWARE CHIRO & REHAB, INC.
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Dates
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Enumeration Date | 11/29/2014
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Last Update Date | 11/29/2014
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Provider Practice Location Address
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Address Line | 100 MARKET ST
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City | BRIDGEVILLE
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State | DE
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Zip | 19933-1127
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Country | US
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Telephone | 302-956-0034
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Fax | 302-956-0643
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | BRIDGEVILLE
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State | DE
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Zip | 19933-0129
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Country | US
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Telephone | 302-956-0034
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Fax | 302-956-0643
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Authorized Official
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Title or Position | OWNER
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Name | JOANES POLYNICE
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Credential |
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Telephone | 323-455-6804
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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 | 20141009154
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License Number State | DE
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