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General NPI Number Information
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NPI Number | 1225449937
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Entity Type | Individual
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Provider Name | DERRICK NOHL D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 8005 MACKENZIE RD
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City | AFFTON
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State | MO
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Zip | 63123-3518
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Country | US
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Telephone | 314-353-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 450 WATERSIDE DR
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City | GROVER
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State | MO
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Zip | 63040-1618
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Country | US
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Telephone | 636-422-0703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2013042355
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License Number State | MO
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