Provider Demographics
NPI:1821408147
Name:PEHUR, DEREK WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:WILLIAM
Last Name:PEHUR
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 1:52775 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2522
Mailing Address - Country:US
Mailing Address - Phone:586-808-5691
Mailing Address - Fax:
Practice Address - Street 1:52775 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-2522
Practice Address - Country:US
Practice Address - Phone:586-808-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor