Provider Demographics
NPI:1508545104
Name:FOUST, DEREK ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ROBERT
Last Name:FOUST
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 1:635 DISCOVERY CT
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3733
Mailing Address - Country:US
Mailing Address - Phone:419-203-4991
Mailing Address - Fax:
Practice Address - Street 1:99-080 KAUHALE ST STE D9
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4114
Practice Address - Country:US
Practice Address - Phone:808-637-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1587111N00000X
GACHIRO10945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor