Healthcare Provider Details

I. General information

NPI: 1700936101
Provider Name (Legal Business Name): DEREK ROLAND FOREMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 E. CALVADA BLVD.#100
PAHRUMP NV
89048-5844
US

IV. Provider business mailing address

2080 E. CALVADA BLVD.#100
PAHRUMP NV
89048-5844
US

V. Phone/Fax

Practice location:
  • Phone: 775-537-6110
  • Fax: 775-537-6151
Mailing address:
  • Phone: 775-537-6110
  • Fax: 775-537-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberB00810
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: