Provider Demographics
NPI:1922192376
Name:DERRICK W. DENMAN DC PA
Entity Type:Organization
Organization Name:DERRICK W. DENMAN DC PA
Other - Org Name:ALTERNATIVE CHIROPRACTIC: A CREATING WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-799-0939
Mailing Address - Street 1:PO BOX 3726
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-799-0939
Mailing Address - Fax:704-799-0935
Practice Address - Street 1:484 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-799-0939
Practice Address - Fax:704-799-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790186CMedicaid
NC790186CMedicaid