Provider Demographics
NPI:1306240080
Name:DEHERRERA, JEREMY SEAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SEAN
Last Name:DEHERRERA
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 1:1643 24TH ST W
Mailing Address - Street 2:STE 203
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2677
Mailing Address - Country:US
Mailing Address - Phone:406-652-5140
Mailing Address - Fax:406-294-2822
Practice Address - Street 1:1643 24TH ST W
Practice Address - Street 2:STE 203
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2677
Practice Address - Country:US
Practice Address - Phone:406-652-5140
Practice Address - Fax:406-294-2822
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor