Provider Demographics
NPI:1619483302
Name:NYREN, DEREK ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ANTHONY
Last Name:NYREN
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 1:8520 STEILACOOM BLVD SW STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4773
Mailing Address - Country:US
Mailing Address - Phone:253-507-7564
Mailing Address - Fax:253-625-7241
Practice Address - Street 1:8520 STEILACOOM BLVD SW STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4773
Practice Address - Country:US
Practice Address - Phone:253-507-7564
Practice Address - Fax:253-625-7241
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60802337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor