Provider Demographics
NPI:1730262155
Name:DE WET, GINA ANNALENE (DC)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:ANNALENE
Last Name:DE WET
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 1:3436 VALLE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2415
Mailing Address - Country:US
Mailing Address - Phone:707-224-2884
Mailing Address - Fax:707-224-0884
Practice Address - Street 1:3436 VALLE VERDE DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2415
Practice Address - Country:US
Practice Address - Phone:707-224-2884
Practice Address - Fax:707-224-0884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0292190Medicare PIN