Provider Demographics
NPI:1619081148
Name:GOMEZ, DELVIN F (DC)
Entity Type:Individual
Prefix:DR
First Name:DELVIN
Middle Name:F
Last Name:GOMEZ
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 1:619 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2303
Mailing Address - Country:US
Mailing Address - Phone:315-295-2262
Mailing Address - Fax:315-295-2263
Practice Address - Street 1:619 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2303
Practice Address - Country:US
Practice Address - Phone:315-295-2262
Practice Address - Fax:315-295-2263
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5899446OtherGHI
NYC09337-9OtherWORKER'S COMPENSATION
NYC09337-9OtherWORKER'S COMPENSATION
NYCC7891Medicare ID - Type Unspecified