Provider Demographics
NPI:1740056977
Name:DUROCHER, DERREK (DC)
Entity type:Individual
Prefix:
First Name:DERREK
Middle Name:
Last Name:DUROCHER
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 1:410 1ST ST E STE A
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-2130
Mailing Address - Country:US
Mailing Address - Phone:406-872-2088
Mailing Address - Fax:
Practice Address - Street 1:410 1ST ST E STE A
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2130
Practice Address - Country:US
Practice Address - Phone:406-872-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-8693111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner