Provider Demographics
NPI:1770959579
Name:DERR, CASEY JAY (DC)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:JAY
Last Name:DERR
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 1:85 RIO ROBLES E
Mailing Address - Street 2:APARTMENT 1232
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1651
Mailing Address - Country:US
Mailing Address - Phone:308-870-4289
Mailing Address - Fax:
Practice Address - Street 1:2044 OLD MIDDLEFIELD WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2402
Practice Address - Country:US
Practice Address - Phone:650-701-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-15
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor