Healthcare Provider Details

I. General information

NPI: 1619632635
Provider Name (Legal Business Name): PRESLEE JANE DEATER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 DEWAR DR STE J
ROCK SPRINGS WY
82901-5757
US

IV. Provider business mailing address

PO BOX 1244
MOUNTAIN VIEW WY
82939-1244
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-3228
  • Fax:
Mailing address:
  • Phone: 307-705-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2108
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: