Provider Demographics
NPI:1730270125
Name:DERRICK, CHRISTOPHER SCOTT (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:DERRICK
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 1:2750 W. VIRGINIA PKWY., STE. 102
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:972-548-1650
Mailing Address - Fax:972-548-1621
Practice Address - Street 1:2750 W. VIRGINIA PKWY., STE. 102
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:972-548-1650
Practice Address - Fax:972-548-1621
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1627176Medicaid
TX8A0252Medicare PIN
TX1627176Medicaid
TXU92835Medicare UPIN