Provider Demographics
NPI:1699456913
Name:DERILUS, SAMANTHA (DC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DERILUS
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 1:17438 81ST LN N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2927
Mailing Address - Country:US
Mailing Address - Phone:561-506-8854
Mailing Address - Fax:
Practice Address - Street 1:1707 W REYNOLDS ST UNIT 102
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4737
Practice Address - Country:US
Practice Address - Phone:813-848-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor