Derek Layne Page Sr., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4279 Issued in TX

Practice address

2920 Oak Park Cir
Suite 101
Fort Worth, TX 76109-1853

Phone

(817) 924-7243

Fax

(817) 924-0284

NPI assigned

Oct 4, 2006

Reactivated

Jul 14, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fort Worth Chiropractic Clinic PLLC

  • Chiropractor
  • Fort Worth, TX
  • NPI 1164055141
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1609962190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 OAK PARK CIR",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761091853",
            "telephone_number": "817-924-7243",
            "fax_number": "817-924-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 OAK PARK CIR",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761091853",
            "telephone_number": "817-924-7243",
            "fax_number": "817-924-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGE",
        "first_name": "DEREK",
        "middle_name": "LAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "deactivation_date": "2020-02-13",
        "reactivation_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "4279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "BCBS",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE LINK",
            "identifier": "8115147",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amrutha Padmasolala, LMSW
• Donald R Paek Sr., MD
• Pafford Medical Services Corporation of Texas, Inc
• Ian Keith Pagdilao, LPC, NCC
• Delaney Elizabeth Page
• Elijah Page
• Sheila Page
• Patti Pagels, PA
• Laura Vita Quito Paglicawan, MD
• Pain Management Intraoperative Monitoring LLC

• Chiropractor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.