Provider Demographics
NPI:1568421188
Name:DELOE, PETER T (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:DELOE
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 1:600 KREAG RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3746
Mailing Address - Country:US
Mailing Address - Phone:585-586-3930
Mailing Address - Fax:
Practice Address - Street 1:600 KREAG RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3746
Practice Address - Country:US
Practice Address - Phone:585-586-3930
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103677ANOtherPREFERRED CARE
NYP2I02583659-9Medicaid
NYX081812OtherWORK COMP.
NYX008181OtherNY ST. LICENSE
NY12267BMedicare ID - Type Unspecified