Provider Demographics
NPI:1851522023
Name:DEPPEN, DREW LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:LOUIS
Last Name:DEPPEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:667 BOYLSTON ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4809
Mailing Address - Country:US
Mailing Address - Phone:224-622-8766
Mailing Address - Fax:617-236-0359
Practice Address - Street 1:667 BOYLSTON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4809
Practice Address - Country:US
Practice Address - Phone:224-622-8766
Practice Address - Fax:617-236-0359
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011479111N00000X
MA3422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor