NPIMap

Organization Active NPI

Deroos Family & Pediatric Health Center PC

  • Chiropractor
  • Cleveland, TN
National Provider Identifier
1770613465
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC1294 Issued in TN
Legal business name
DEROOS FAMILY & PEDIATRIC HEALTH CENTER PC
Practice address
340 Sunset Dr NW
Cleveland, TN 37312-5349
Phone
(423) 614-5654
Fax
(423) 614-5645
NPI assigned
Mar 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Timothy David Deroos, DCNPI 1851421523
Title
President
Phone
(423) 614-5654

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC1294 TN Primary

Addresses

Primary practice location

340 Sunset Dr NW
Cleveland, TN 37312-5349

Mailing address

340 Sunset Dr NW
Cleveland, TN 37312-5349
Phone (423) 614-5654

Other identifiers 2

IdentifierTypeStateIssuer
3043835OtherTNBCBS PROVIDER ID NUMBER
3730366MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770613465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SUNSET DR NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373125349",
            "telephone_number": "423-614-5654",
            "fax_number": "423-614-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 SUNSET DR NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373125349",
            "telephone_number": "423-614-5654",
            "fax_number": "423-614-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEROOS FAMILY & PEDIATRIC HEALTH CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEROOS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-614-5654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TN",
            "license": "DC1294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID NUMBER",
            "identifier": "3043835",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3730366",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.