1376683565 NPI number — HENLOPEN CHIROPRACTIC CENTER PA INC

Table of content: (NPI 1376683565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376683565 NPI number — HENLOPEN CHIROPRACTIC CENTER PA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENLOPEN CHIROPRACTIC CENTER PA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376683565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 40450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44140-0450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-871-4700
Provider Business Mailing Address Fax Number:
440-871-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 SAVANNAH RD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-1420
Provider Business Practice Location Address Fax Number:
302-645-0878
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOBBS
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
302-644-1420

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  F10000327 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: UPN 177 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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