Provider Demographics
NPI:1235229550
Name:DELARYE, DOUGLAS CLEMENT (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CLEMENT
Last Name:DELARYE
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 1:4711 GOLF RD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-329-9588
Mailing Address - Fax:847-329-9606
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:413
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-329-9588
Practice Address - Fax:847-329-9606
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor