Provider Demographics
NPI:1922764638
Name:DELORME, JESHUA MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JESHUA
Middle Name:MICHAEL
Last Name:DELORME
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 1:2504 1ST CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-1949
Mailing Address - Country:US
Mailing Address - Phone:608-897-2136
Mailing Address - Fax:608-897-8366
Practice Address - Street 1:2504 1ST CENTER AVE
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-1949
Practice Address - Country:US
Practice Address - Phone:608-897-2136
Practice Address - Fax:608-897-8366
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5694-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor