Provider Demographics
NPI:1114976206
Name:GOMEZ, LIDIA GUADALUPE (DC)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:GUADALUPE
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 WALLING CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3056
Mailing Address - Country:US
Mailing Address - Phone:563-324-5934
Mailing Address - Fax:
Practice Address - Street 1:1909 WALLING CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-3056
Practice Address - Country:US
Practice Address - Phone:563-343-2686
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor