Provider Demographics
NPI:1659360907
Name:DELU, KENNETH ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALEXANDER
Last Name:DELU
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 1:1420 W KETTLEMAN LN
Mailing Address - Street 2:B3
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4557
Mailing Address - Country:US
Mailing Address - Phone:209-333-8690
Mailing Address - Fax:209-333-8692
Practice Address - Street 1:1420 W KETTLEMAN LN
Practice Address - Street 2:B3
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4557
Practice Address - Country:US
Practice Address - Phone:209-333-8690
Practice Address - Fax:209-333-8692
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0197550Medicare ID - Type Unspecified
CA19755Medicare UPIN