Healthcare Provider Details

I. General information

NPI: 1265062749
Provider Name (Legal Business Name): DEREK ALAN SPIELES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 N MAIN ST
MINSTER OH
45865-9537
US

IV. Provider business mailing address

496 N MAIN ST
MINSTER OH
45865-9537
US

V. Phone/Fax

Practice location:
  • Phone: 419-628-2718
  • Fax:
Mailing address:
  • Phone: 419-628-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-04947
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: