Provider Demographics
NPI:1942498605
Name:BRUMFIELD, DEIDRA A (DC)
Entity Type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:A
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-0328
Mailing Address - Country:US
Mailing Address - Phone:304-519-9270
Mailing Address - Fax:304-519-9271
Practice Address - Street 1:3857 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-0328
Practice Address - Country:US
Practice Address - Phone:304-519-9270
Practice Address - Fax:304-519-9271
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3743111N00000X
OH4164111N00000X
KY249484111N00000X
WV897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1942498605Medicaid