Provider Demographics
NPI:1831840834
Name:DERVISH, TRISTEN J (DC)
Entity type:Individual
Prefix:DR
First Name:TRISTEN
Middle Name:J
Last Name:DERVISH
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 1:2315 ESPINOSA PL # 4-303
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2293
Mailing Address - Country:US
Mailing Address - Phone:845-664-5322
Mailing Address - Fax:
Practice Address - Street 1:899 LOGAN ST.
Practice Address - Street 2:SUITE 105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:303-831-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor