Healthcare Provider Details

I. General information

NPI: 1831840834
Provider Name (Legal Business Name): TRISTEN J DERVISH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W 44TH AVE
WHEAT RIDGE CO
80033-4722
US

IV. Provider business mailing address

9110 E 52ND DR
DENVER CO
80238-3794
US

V. Phone/Fax

Practice location:
  • Phone: 303-423-1925
  • Fax: 303-420-1123
Mailing address:
  • Phone: 845-664-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0008465
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: