Provider Demographics
NPI:1205081726
Name:RICE, DEREK (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:RICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 328
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3792
Mailing Address - Country:US
Mailing Address - Phone:619-356-0314
Mailing Address - Fax:888-308-0385
Practice Address - Street 1:2515 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 328
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3792
Practice Address - Country:US
Practice Address - Phone:619-356-0314
Practice Address - Fax:888-308-0385
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5358111N00000X
CADC-31895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor