Healthcare Provider Details

I. General information

NPI: 1194476143
Provider Name (Legal Business Name): ADALIZ MARIE GOMEZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 ELM ST STE 4
MONROE CT
06468-6201
US

IV. Provider business mailing address

292 ELM ST STE 4
MONROE CT
06468-6201
US

V. Phone/Fax

Practice location:
  • Phone: 203-590-3337
  • Fax:
Mailing address:
  • Phone: 203-590-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number002226
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: