Provider Demographics
NPI:1285867465
Name:HERMS, DEREK RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:RICHARD
Last Name:HERMS
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 1:1500 W SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5950
Mailing Address - Country:US
Mailing Address - Phone:817-416-6116
Mailing Address - Fax:817-410-9411
Practice Address - Street 1:1500 W SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5950
Practice Address - Country:US
Practice Address - Phone:817-416-6116
Practice Address - Fax:817-410-9411
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor