Provider Demographics
NPI:1285650606
Name:HORNBACK, DARRYL JOE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:JOE
Last Name:HORNBACK
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 1:7581 S WILLOW DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5033
Mailing Address - Country:US
Mailing Address - Phone:480-730-5154
Mailing Address - Fax:480-730-5154
Practice Address - Street 1:7581 S WILLOW DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5033
Practice Address - Country:US
Practice Address - Phone:480-730-5154
Practice Address - Fax:480-730-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4325Medicare ID - Type Unspecified
T76829Medicare UPIN