Provider Demographics
NPI:1558442988
Name:PINCKNEY, DERRIK SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DERRIK
Middle Name:SCOTT
Last Name:PINCKNEY
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 1:303 OCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2637
Mailing Address - Country:US
Mailing Address - Phone:507-532-7458
Mailing Address - Fax:507-532-5612
Practice Address - Street 1:303 OCONNELL ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2637
Practice Address - Country:US
Practice Address - Phone:507-532-7458
Practice Address - Fax:507-532-5612
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN205187700Medicaid
MN48660OtherSIOUX VALLEY HEALTH PLAN
MN83G61PIOtherBCBS
MNV07613Medicare UPIN
MN83G61PIOtherBCBS