Provider Demographics
NPI:1497757983
Name:DEFRIES, DENISE LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LYNNE
Last Name:DEFRIES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2946
Mailing Address - Country:US
Mailing Address - Phone:484-480-4544
Mailing Address - Fax:484-480-4546
Practice Address - Street 1:2870 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-2946
Practice Address - Country:US
Practice Address - Phone:484-480-4544
Practice Address - Fax:484-480-4546
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003713-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA153029OtherUNITEDHEALTH CARE
PA153029OtherCAPITAL BLUE CROSS
PA153029OtherMAIL HANDLERS
PA3314201OtherAETNA
PA3725263OtherCIGNA
PA153029OtherBC/BS - FEP
PA008458900OtherKEYSTONE HEALTH PLAN EAST
PA153029OtherWPS-TRICARE
PA153029OtherDEVON HEALTH CARE
PA153029OtherGEM
PA0084589000OtherINDEPENCE BLUE CROSS
PA153029OtherHIGHMARK BLUE SHIELD
PA153029OtherAMERIHEALTH
PA153029OtherCORESOURCE
PA153029OtherWPS-TRICARE