Provider Demographics
NPI:1558993287
Name:MOBLEY, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 JOHNNIE DODDS BLVD # 7
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6155
Mailing Address - Country:US
Mailing Address - Phone:843-284-6601
Mailing Address - Fax:
Practice Address - Street 1:1039 JOHNNIE DODDS BLVD # 7
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6155
Practice Address - Country:US
Practice Address - Phone:843-284-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor