Provider Demographics
NPI:1437266889
Name:DELGADILLO, MARC J (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:DELGADILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2121 E 2ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2056
Mailing Address - Country:US
Mailing Address - Phone:307-266-2225
Mailing Address - Fax:307-266-4634
Practice Address - Street 1:2121 E 2ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2056
Practice Address - Country:US
Practice Address - Phone:307-266-2225
Practice Address - Fax:307-266-4634
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYT44190Medicare UPIN