Provider Demographics
NPI:1427073113
Name:CLEM, DEREK COLLIN (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:COLLIN
Last Name:CLEM
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 1:21 ORCHARD PARK DR
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3528
Mailing Address - Country:US
Mailing Address - Phone:864-213-9919
Mailing Address - Fax:864-213-9918
Practice Address - Street 1:21 ORCHARD PARK DR
Practice Address - Street 2:SUITE E-2
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3528
Practice Address - Country:US
Practice Address - Phone:864-213-9919
Practice Address - Fax:864-213-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor