Provider Demographics
NPI:1275249682
Name:DELGADO, JOSE LUIS (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:DELGADO
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 1:1125 E WATERS EDGE CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-4037
Mailing Address - Country:US
Mailing Address - Phone:316-300-5505
Mailing Address - Fax:
Practice Address - Street 1:105 S ANDOVER RD STE E
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7926
Practice Address - Country:US
Practice Address - Phone:316-733-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor