Provider Demographics
NPI:1730730037
Name:MCANINCH, DERRICK JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:JAMES
Last Name:MCANINCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7959
Mailing Address - Country:US
Mailing Address - Phone:716-628-5672
Mailing Address - Fax:
Practice Address - Street 1:6933 TONAWANDA CREEK RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-7959
Practice Address - Country:US
Practice Address - Phone:716-628-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor