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General NPI Number Information
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NPI Number | 1982169165
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Entity Type | Individual
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Provider Name | MARIE J DERILUS
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 102 E OLD BOWMAN RD STE C
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City | ROUND ROCK
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State | TX
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Zip | 78664-2296
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Country | US
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Telephone | 512-589-2702
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Fax |
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Provider Business Mailing Address
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Address Line | 102 E OLD BOWMAN RD STE C
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City | ROUND ROCK
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State | TX
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Zip | 78664-2296
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Country | US
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Telephone | 512-589-2702
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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 | 13954
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License Number State | TX
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