Provider Demographics
NPI:1134104409
Name:DALEY, MICHAEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:DALEY
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 1:107 5TH ST SE STE 9
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4269
Mailing Address - Country:US
Mailing Address - Phone:330-745-2033
Mailing Address - Fax:330-745-0282
Practice Address - Street 1:107 5TH ST SE STE 9
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4269
Practice Address - Country:US
Practice Address - Phone:330-745-2033
Practice Address - Fax:330-745-0282
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633903Medicaid
OH2633903Medicaid
V07264Medicare UPIN
DA4173071Medicare PIN