Provider Demographics
NPI:1295960292
Name:DERBY, CHAD ALAN (ATC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ALAN
Last Name:DERBY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TRUEBLOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-1757
Mailing Address - Country:US
Mailing Address - Phone:641-673-1093
Mailing Address - Fax:641-673-1373
Practice Address - Street 1:201 TRUEBLOOD AVE
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-1757
Practice Address - Country:US
Practice Address - Phone:641-673-1093
Practice Address - Fax:641-673-1373
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0007222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer