Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | F1-0000721 | DE |
N | 208D00000X | General Practice Physician | F1-0000721 | DE |
NPI | 1316198005 |
---|---|
Provider Name | Trevor Kent Ennis |
First Address | Middletown, DE 19709-1463 |
Second Address | Middletown, DE 19709-1463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 23/04/2020 |