Provider Demographics
NPI:1417132283
Name:DELAMARE, GREGORY T (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:DELAMARE
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 1:1173 N DIXIE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1200
Mailing Address - Country:US
Mailing Address - Phone:909-592-7040
Mailing Address - Fax:
Practice Address - Street 1:1173 N DIXIE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1200
Practice Address - Country:US
Practice Address - Phone:909-592-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA21596Medicare UPIN