Provider Demographics
NPI:1194476143
Name:GOMEZ, ADALIZ MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:ADALIZ
Middle Name:MARIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 GRENELLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2310
Mailing Address - Country:US
Mailing Address - Phone:973-563-1081
Mailing Address - Fax:
Practice Address - Street 1:133 LOUIS ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4517
Practice Address - Country:US
Practice Address - Phone:860-667-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty