Provider Demographics
NPI:1437972866
Name:DECKER, DESTINY (DC)
Entity type:Individual
Prefix:DR
First Name:DESTINY
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 WHITEHEAD HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14815-9720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4838
Practice Address - Country:US
Practice Address - Phone:607-857-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104558033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor