Provider Demographics
NPI:1124050174
Name:DEANY, DEIDRE MARIE (DC)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:MARIE
Last Name:DEANY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 APOLLO BEACH BLVD APT 207
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2034
Mailing Address - Country:US
Mailing Address - Phone:815-793-4890
Mailing Address - Fax:
Practice Address - Street 1:110 W SHELL POINT RD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3705
Practice Address - Country:US
Practice Address - Phone:815-793-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009826111N00000X
FLCH12125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3832004OtherBCBS PROVIDER NUMBER
IL3832004OtherBCBS PROVIDER NUMBER