Provider Demographics
NPI:1568548113
Name:DEITCH, NORMAN (DC)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:DEITCH
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 1:2125 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6260
Mailing Address - Country:US
Mailing Address - Phone:760-231-1116
Mailing Address - Fax:760-231-6429
Practice Address - Street 1:2125 S EL CAMINO REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6260
Practice Address - Country:US
Practice Address - Phone:760-231-1116
Practice Address - Fax:760-231-6429
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0007357745OtherAETNA
CA671144OtherCONNECTICARE
CAZZZ66356ZOtherBLUE SHIELD
CAZZZ09734ZOtherBLUE CROSS
CA0007357745OtherAETNA
CA671144OtherCONNECTICARE