Provider Demographics
NPI:1306383963
Name:DE WET CHIROPRACTIC PROF. CORP.
Entity Type:Organization
Organization Name:DE WET CHIROPRACTIC PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:ANNALENE
Authorized Official - Last Name:DEWET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-224-2884
Mailing Address - Street 1:3436 VALLE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2415
Mailing Address - Country:US
Mailing Address - Phone:707-224-2884
Mailing Address - Fax:707-224-0884
Practice Address - Street 1:3436 VALLE VERDE DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2415
Practice Address - Country:US
Practice Address - Phone:707-224-2884
Practice Address - Fax:707-224-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty