Provider Demographics
NPI:1891520128
Name:WARREN, DESIRAE (DC)
Entity type:Individual
Prefix:DR
First Name:DESIRAE
Middle Name:
Last Name:WARREN
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 1:8419 CARROLLTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2731
Mailing Address - Country:US
Mailing Address - Phone:678-467-1056
Mailing Address - Fax:
Practice Address - Street 1:3737 BRANCH AVE STE 1340
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1405
Practice Address - Country:US
Practice Address - Phone:888-570-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty