Provider Demographics
NPI:1689663809
Name:DELGADO, JORGE R (DC)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:DELGADO
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 1:10 HANOFEE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-2734
Mailing Address - Country:US
Mailing Address - Phone:845-292-3455
Mailing Address - Fax:845-295-0186
Practice Address - Street 1:111 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-4315
Practice Address - Country:US
Practice Address - Phone:845-292-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04826111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T53040Medicare UPIN
X28041Medicare ID - Type Unspecified