Provider Demographics
NPI:1003557083
Name:CHALIFOUR, DEREK MATTHEW
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:MATTHEW
Last Name:CHALIFOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2109
Mailing Address - Country:US
Mailing Address - Phone:907-240-4381
Mailing Address - Fax:
Practice Address - Street 1:1113 W FIREWEED LN STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1753
Practice Address - Country:US
Practice Address - Phone:907-272-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist