Provider Demographics
NPI:1528418860
Name:DERR CHIROPRACTIC
Entity Type:Organization
Organization Name:DERR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-479-9487
Mailing Address - Street 1:463 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1760
Mailing Address - Country:US
Mailing Address - Phone:423-479-9487
Mailing Address - Fax:423-472-8570
Practice Address - Street 1:463 1ST ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1760
Practice Address - Country:US
Practice Address - Phone:423-479-9487
Practice Address - Fax:423-472-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000329111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0021996OtherBLUE CROSS BLUE SHIELD OF TN
TN3672790OtherMEDICARE
TN616331OtherUNITED HEALTH CARE
TNT74539OtherUPIN