Provider Demographics
NPI:1619107927
Name:SOEHREN, DELOS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DELOS
Middle Name:
Last Name:SOEHREN
Suffix:JR
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 1:79245 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7247
Mailing Address - Country:US
Mailing Address - Phone:760-771-5450
Mailing Address - Fax:
Practice Address - Street 1:79245 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7247
Practice Address - Country:US
Practice Address - Phone:760-771-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30014111N00000X
CARHC 00166643111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology