Provider Demographics
NPI:1013019553
Name:DIERKHISING, DARRICK A (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRICK
Middle Name:A
Last Name:DIERKHISING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-9813
Mailing Address - Country:US
Mailing Address - Phone:320-271-0049
Mailing Address - Fax:
Practice Address - Street 1:1058 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6056
Practice Address - Country:US
Practice Address - Phone:651-439-6500
Practice Address - Fax:651-439-6501
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV07223Medicare UPIN