Provider Demographics
NPI:1992917025
Name:PIKE CREEK CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:PIKE CREEK CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-737-9601
Mailing Address - Street 1:1450 CAPITOL TRL
Mailing Address - Street 2:SUITE #103
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5700
Mailing Address - Country:US
Mailing Address - Phone:302-737-9601
Mailing Address - Fax:302-737-9604
Practice Address - Street 1:1450 CAPITOL TRL
Practice Address - Street 2:SUITE #103
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5700
Practice Address - Country:US
Practice Address - Phone:302-737-9601
Practice Address - Fax:302-737-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty