1427391614 NPI number — BRANDYWINE HEALTH AND WELLNESS LLC

Table of content: (NPI 1427391614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427391614 NPI number — BRANDYWINE HEALTH AND WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANDYWINE HEALTH AND WELLNESS LLC
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:
6
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:
1427391614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1536 KIRKWOOD HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19711-5716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-454-1230
Provider Business Mailing Address Fax Number:
302-454-5855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2036 FOULK ROAD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-475-4200
Provider Business Practice Location Address Fax Number:
302-475-4201
Provider Enumeration Date:
04/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
STACY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
302-454-1230

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  F1-0000855 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com