Provider Demographics
NPI:1447464631
Name:DEPELTEAU, AUDREY M (DC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:DEPELTEAU
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 1:42700 BOB HOPE DR
Mailing Address - Street 2:SUITE # 315
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4434
Mailing Address - Country:US
Mailing Address - Phone:760-777-2363
Mailing Address - Fax:760-321-1969
Practice Address - Street 1:42700 BOB HOPE DR
Practice Address - Street 2:SUITE # 315
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4434
Practice Address - Country:US
Practice Address - Phone:760-777-2363
Practice Address - Fax:760-321-1969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor