Provider Demographics
NPI:1700854684
Name:DEVRIES, DOUGLAS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:DEVRIES
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 1:144 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8127
Mailing Address - Country:US
Mailing Address - Phone:928-726-8847
Mailing Address - Fax:928-341-0417
Practice Address - Street 1:144 W 32ND ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8127
Practice Address - Country:US
Practice Address - Phone:928-726-8847
Practice Address - Fax:928-341-0417
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-01-21
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
AZ4604111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ350047376OtherRAILROAD MEDICARE
AZ60918Medicare PIN