Provider Demographics
NPI:1154480127
Name:DELVIN F. GOMEZ, D.C.
Entity Type:Organization
Organization Name:DELVIN F. GOMEZ, D.C.
Other - Org Name:BACK TO HEALTH CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-295-2262
Mailing Address - Street 1:619 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2303
Mailing Address - Country:US
Mailing Address - Phone:315-295-2262
Mailing Address - Fax:315-295-2263
Practice Address - Street 1:619 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2303
Practice Address - Country:US
Practice Address - Phone:315-295-2262
Practice Address - Fax:315-295-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5899446OtherGHI
NYCO9337-9OtherWORKERS COMPENSATION
NYCO9337-9OtherWORKERS COMPENSATION
NYCC7891Medicare ID - Type UnspecifiedMEDICARE ID