Provider Demographics
NPI:1033270749
Name:DELICH, BETTYLOU (DC)
Entity Type:Individual
Prefix:DR
First Name:BETTYLOU
Middle Name:
Last Name:DELICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 N OAKLAND AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2746
Mailing Address - Country:US
Mailing Address - Phone:414-962-0700
Mailing Address - Fax:414-962-0442
Practice Address - Street 1:3510 N OAKLAND AVE
Practice Address - Street 2:STE 201
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2746
Practice Address - Country:US
Practice Address - Phone:414-962-0700
Practice Address - Fax:414-962-0442
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3710-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38965000Medicaid
WI38965000Medicaid