Provider Demographics
NPI:1265526776
Name:DERRICK W. DENMAN D.C. P.A.
Entity type:Organization
Organization Name:DERRICK W. DENMAN D.C. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
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:
Authorized Official - Phone:704-735-8226
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093
Mailing Address - Country:US
Mailing Address - Phone:704-735-8226
Mailing Address - Fax:704-735-8280
Practice Address - Street 1:108 NEWBOLD STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-735-8226
Practice Address - Fax:704-735-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790186CMedicaid
NC2453954Medicare ID - Type Unspecified