Provider Demographics
NPI:1477898963
Name:STUDER, DERREK WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:DERREK
Middle Name:WESLEY
Last Name:STUDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 FOXFIRE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9412
Mailing Address - Country:US
Mailing Address - Phone:270-352-4444
Mailing Address - Fax:270-352-4445
Practice Address - Street 1:1003 N WILSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1475
Practice Address - Country:US
Practice Address - Phone:270-352-4444
Practice Address - Fax:270-352-4445
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12479949OtherCAQH
KYK178271Medicare PIN