Provider Demographics
NPI:1538372750
Name:DYNAMIC THERAPEUTICS INC.
Entity type:Organization
Organization Name:DYNAMIC THERAPEUTICS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-322-3304
Mailing Address - Street 1:819 CHURCHMANS ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3152
Mailing Address - Country:US
Mailing Address - Phone:302-322-3304
Mailing Address - Fax:302-322-3306
Practice Address - Street 1:819 CHURCHMANS ROAD EXT
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3152
Practice Address - Country:US
Practice Address - Phone:302-322-3304
Practice Address - Fax:302-322-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0529674000OtherKEYSTONE HEALTH PLAN EAST
DE2122380OtherMAMSI/OPTIMA CHOICE
DE409623OtherCOVENTRY
DE2219986OtherAETNA
DE2276361OtherFIRST HEALTH
DE0529674000OtherAMERIHEALTH
DE=========OtherCIGNA
DE=========OtherUNITED HEALTH CARE
DE2219986OtherAETNA