Provider Demographics
NPI:1336381920
Name:DEROCHER, BRENT JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:DEROCHER
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 1:1128 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-1340
Mailing Address - Country:US
Mailing Address - Phone:515-981-0036
Mailing Address - Fax:
Practice Address - Street 1:1128 SUNSET DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-1340
Practice Address - Country:US
Practice Address - Phone:515-981-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor