Provider Demographics
NPI:1609991264
Name:DE PELICHY, REGINALD G (DC)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:G
Last Name:DE PELICHY
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 1:41 CAMINO EL ALTO NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-9570
Mailing Address - Country:US
Mailing Address - Phone:505-292-4859
Mailing Address - Fax:505-293-7045
Practice Address - Street 1:615 ORTIZ DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1446
Practice Address - Country:US
Practice Address - Phone:505-266-0297
Practice Address - Fax:505-266-8622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM424111NN1001X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NI0900XChiropractic ProvidersChiropractorInternist