Provider Demographics
NPI:1992373179
Name:MUNSON, DEREK D (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:D
Last Name:MUNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5570 WILSON STREET SW
Mailing Address - Street 2:SUITE NM
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418
Mailing Address - Country:US
Mailing Address - Phone:616-259-9835
Mailing Address - Fax:616-258-8897
Practice Address - Street 1:5570 WILSON STREET SW
Practice Address - Street 2:SUITE NM
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418
Practice Address - Country:US
Practice Address - Phone:616-259-9835
Practice Address - Fax:616-258-8897
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301011109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor