Provider Demographics
NPI:1043856438
Name:PIETROBON, DERRIK (DC)
Entity Type:Individual
Prefix:
First Name:DERRIK
Middle Name:
Last Name:PIETROBON
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 1:6049 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2603
Mailing Address - Country:US
Mailing Address - Phone:719-637-7900
Mailing Address - Fax:719-637-7654
Practice Address - Street 1:6049 BARNES RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2603
Practice Address - Country:US
Practice Address - Phone:719-637-7900
Practice Address - Fax:719-637-7654
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013472111N00000X
COCHR.0008366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor