Provider Demographics
NPI:1336030188
Name:NEGRON CASTRO, DEREK MANUEL (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:MANUEL
Last Name:NEGRON CASTRO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JENNINGS MILL PKWY APT 4306
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7473
Mailing Address - Country:US
Mailing Address - Phone:786-932-9840
Mailing Address - Fax:
Practice Address - Street 1:359 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4843
Practice Address - Country:US
Practice Address - Phone:786-932-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor