Provider Demographics
NPI:1922248285
Name:PELOFSKY, DEREK SCOTT (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:SCOTT
Last Name:PELOFSKY
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 RANDOLPH RD
Mailing Address - Street 2:STE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1587
Mailing Address - Country:US
Mailing Address - Phone:310-383-7360
Mailing Address - Fax:
Practice Address - Street 1:2200 RANDOLPH RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1587
Practice Address - Country:US
Practice Address - Phone:704-372-9292
Practice Address - Fax:704-372-9298
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor