Provider Demographics
NPI:1285659318
Name:LEVY, DEREK V (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:V
Last Name:LEVY
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 1:950 AVIATION BLVD
Mailing Address - Street 2:#K
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4010
Mailing Address - Country:US
Mailing Address - Phone:310-920-6645
Mailing Address - Fax:
Practice Address - Street 1:950 AVIATION BLVD
Practice Address - Street 2:#K
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4010
Practice Address - Country:US
Practice Address - Phone:310-920-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC016465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18341Medicare ID - Type Unspecified