Provider Demographics
NPI:1316024524
Name:PRATT, DERRICK WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:WILLIAM
Last Name:PRATT
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 1:102 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815
Mailing Address - Country:US
Mailing Address - Phone:509-782-1312
Mailing Address - Fax:509-782-1733
Practice Address - Street 1:102 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815
Practice Address - Country:US
Practice Address - Phone:509-782-1312
Practice Address - Fax:509-782-1733
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151155OtherL&I
WAAB32652Medicare ID - Type Unspecified
WAG8869244Medicare PIN
U91766Medicare UPIN