Provider Demographics
NPI:1467656678
Name:DERRY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DERRY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:TREVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-851-2475
Mailing Address - Street 1:12919 STROH RANCH COURT
Mailing Address - Street 2:UNIT B
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:720-851-2475
Mailing Address - Fax:720-851-2476
Practice Address - Street 1:12919 STROH RANCH COURT
Practice Address - Street 2:UNIT B
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:720-851-2475
Practice Address - Fax:720-851-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC491388Medicare ID - Type Unspecified