| NPI | 1225500093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR KENT ENNIS Owner/President 302-376-5830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2021-08-25 |