Provider Demographics
NPI:1972794022
Name:DELOREY, NATHAN DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:DELOREY
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 1:2181 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4641
Mailing Address - Country:US
Mailing Address - Phone:920-965-6600
Mailing Address - Fax:920-965-6601
Practice Address - Street 1:2181 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4641
Practice Address - Country:US
Practice Address - Phone:920-965-6600
Practice Address - Fax:920-965-6601
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3678-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972794022OtherMEDICARE NPI
WI38935600Medicaid
WI1972794022OtherMEDICARE NPI