Derek Wayne Birch
Individual provider Active NPI Chiropractor · Riverton, UT
NPI 1174569248 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1174569248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4865482-1202 (UT)
- Practice address
- 2364 W 12600 S
Riverton, UT 84065-7109 - Phone
- (801) 446-2131
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4865482-1202 | UT | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| First Health Choice | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4865482-1202 | UT | Yes |
Addresses
Primary practice location
2364 W 12600 S
Riverton, UT 84065-7109
Mailing address
420 W 2450 N
Lehi, UT 84043-3118
Phone (801) 768-1445
Other providers in Riverton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.