Provider Demographics
NPI:1487602678
Name:AMREIN, DEREK (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:AMREIN
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 1:20325 N 51ST AVE
Mailing Address - Street 2:#108
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5674
Mailing Address - Country:US
Mailing Address - Phone:623-561-2511
Mailing Address - Fax:623-581-0845
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:#108
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:623-561-2511
Practice Address - Fax:623-581-0845
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor