Provider Demographics
NPI:1750494985
Name:DERAMUS, TONY WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:WESLEY
Last Name:DERAMUS
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 1:123 BLUE HERON DR
Mailing Address - Street 2:STE 104
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3192
Mailing Address - Country:US
Mailing Address - Phone:936-582-0404
Mailing Address - Fax:936-582-0410
Practice Address - Street 1:123 BLUE HERON DR
Practice Address - Street 2:STE 104
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3192
Practice Address - Country:US
Practice Address - Phone:936-582-0404
Practice Address - Fax:936-582-0410
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8344111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609357Medicare ID - Type Unspecified
TXU79466Medicare UPIN