Organization
DEROOS FAMILY & PEDIATRIC HEALTH CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY DAVID DEROOS DC (PRESIDENT)
(423) 614-5654
Entity
Organization
Contact information
Practice address
340 SUNSET DR NW, CLEVELAND, TN 37312-5349
(423) 614-5654
(423) 614-5645
Mailing address
340 SUNSET DR NW, CLEVELAND, TN 37312-5349
(423) 614-5654
(423) 614-5645
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC1294
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3043835
BCBS PROVIDER ID NUMBER
TN
05
—
3730366
—
TN
Enumeration date
03/06/2007
Last updated
08/22/2020
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