MEDICARE: DR. DEREK ROBERT BLACK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	111N00000X	Chiropractor	2227	OH

General Provider Information

NPI Number	:	1881781490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK ROBERT BLACK D.C.

Provider Business Mailing Address
First Line	:	3060 DAYTON XENIA RD
Second Line	:	SUITE A
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-6308
Country	:	US
Telephone Number	:	937-427-2225
Fax Number	:	937-431-1722

Provider Business Practice Location Address
First Line	:	3060 DAYTON XENIA RD
Second Line	:	SUITE A
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-6308
Country	:	US
Telephone Number	:	937-427-2225
Fax Number	:	937-431-1722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/24/2022

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