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General NPI Number Information
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NPI Number | 1306383963
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Entity Type | Organization
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Legal Business Name | DE WET CHIROPRACTIC PROF. CORP.
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 3436 VALLE VERDE DR
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City | NAPA
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State | CA
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Zip | 94558-2415
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Country | US
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Telephone | 707-224-2884
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Fax | 707-224-0884
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Provider Business Mailing Address
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Address Line | 3436 VALLE VERDE DR
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City | NAPA
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State | CA
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Zip | 94558-2415
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Country | US
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Telephone | 707-224-2884
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Fax | 707-224-0884
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Authorized Official
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Title or Position | CEO
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Name | DR. GINA ANNALENE DEWET
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Credential | D.C
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Telephone | 707-224-2884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 27241
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License Number State | CA
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