Provider Demographics
NPI:1154795912
Name:DELAIRE CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:DELAIRE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DELAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-320-4123
Mailing Address - Street 1:27620 LANDAU BLVD
Mailing Address - Street 2:STE. 1
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5540
Mailing Address - Country:US
Mailing Address - Phone:760-320-4123
Mailing Address - Fax:760-320-0801
Practice Address - Street 1:27620 LANDAU BLVD
Practice Address - Street 2:STE. 1
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5540
Practice Address - Country:US
Practice Address - Phone:760-320-4123
Practice Address - Fax:760-320-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCO216660OtherMEDICARE
CAU66004Medicare UPIN