Provider Demographics
NPI:1134311376
Name:COULOMBE, DARRYL LOREN (BA, BS, DC)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:LOREN
Last Name:COULOMBE
Suffix:
Gender:M
Credentials:BA, BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 VANDERCOOK WAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3902
Mailing Address - Country:US
Mailing Address - Phone:360-425-6620
Mailing Address - Fax:360-425-1277
Practice Address - Street 1:1312 VANDERCOOK WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3902
Practice Address - Country:US
Practice Address - Phone:360-425-6620
Practice Address - Fax:604-251-2773
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor