Provider Demographics
NPI:1093163859
Name:DEIS, DEZERAE CHRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEZERAE
Middle Name:CHRISTINE
Last Name:DEIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DEZERAE
Other - Middle Name:CHRISTINE
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4723 MEREDETH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4723 MEREDETH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5359
Practice Address - Country:US
Practice Address - Phone:712-215-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor