Provider Demographics
NPI:1144474750
Name:DELAWARE CHIROPRACTIC AT TROLLEY SQUARE
Entity type:Organization
Organization Name:DELAWARE CHIROPRACTIC AT TROLLEY SQUARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOWLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-777-3431
Mailing Address - Street 1:26B TROLLEY SQUARE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806
Mailing Address - Country:US
Mailing Address - Phone:302-777-3431
Mailing Address - Fax:302-442-7176
Practice Address - Street 1:26B TROLLEY SQUARE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-777-3431
Practice Address - Fax:302-442-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
DEFL-0000460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty