Provider Demographics
NPI:1790597060
Name:DELKESKAMP, PETER TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:TIMOTHY
Last Name:DELKESKAMP
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 1:3565 S HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7339
Mailing Address - Country:US
Mailing Address - Phone:805-544-8884
Mailing Address - Fax:
Practice Address - Street 1:3565 S HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7339
Practice Address - Country:US
Practice Address - Phone:805-544-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor