1205803780 NPI number — DR. DARYL G DAMRON D.C.

Table of content: DR. DARYL G DAMRON D.C. (NPI 1205803780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205803780 NPI number — DR. DARYL G DAMRON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMRON
Provider First Name:
DARYL
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205803780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 WILLOWDALE CT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-820-6311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 N ADELAIDE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48430-2670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-629-2245
Provider Business Practice Location Address Fax Number:
810-629-6535
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301006527 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 5601003439 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OB55077 . This is a "BCBS ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1002998 . This is a "MCLAREN HEALTH PLAN ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950B55077 . This is a "HEALTHPLUS ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P60609 . This is a "BCN ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1935260 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00000552 . This is a "TRAVELERS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com