1154480127 NPI number — DELVIN F. GOMEZ, D.C.

Table of content: (NPI 1154480127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154480127 NPI number — DELVIN F. GOMEZ, D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELVIN F. GOMEZ, D.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BACK TO HEALTH CHIROPRACTIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154480127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 W GENESEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13204-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-295-2262
Provider Business Mailing Address Fax Number:
315-295-2263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 W GENESEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13204-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-295-2262
Provider Business Practice Location Address Fax Number:
315-295-2263
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
DELVIN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-295-2262

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X009337 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5899446 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO9337-9 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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