Provider Demographics
NPI:1750658530
Name:DEINES, NATHAN W (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:W
Last Name:DEINES
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 1:840 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3506
Mailing Address - Country:US
Mailing Address - Phone:563-468-3109
Mailing Address - Fax:
Practice Address - Street 1:25 E ALGER ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3911
Practice Address - Country:US
Practice Address - Phone:307-673-5075
Practice Address - Fax:307-673-5085
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor