Provider Demographics
NPI:1093051096
Name:DEVRIES, CASEY MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MARK
Last Name:DEVRIES
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:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-0104
Mailing Address - Country:US
Mailing Address - Phone:319-329-4813
Mailing Address - Fax:
Practice Address - Street 1:1260 35TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1712
Practice Address - Country:US
Practice Address - Phone:319-377-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002689A111N00000X
IA075589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor