Provider Demographics
NPI:1366452948
Name:COTY, DARRYL L (DC)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:L
Last Name:COTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 N MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-1360
Mailing Address - Country:US
Mailing Address - Phone:260-824-9944
Mailing Address - Fax:260-824-9945
Practice Address - Street 1:1169 N MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1360
Practice Address - Country:US
Practice Address - Phone:260-824-9944
Practice Address - Fax:260-824-9945
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001074A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000322989OtherBLUE CROSS
INT34858Medicare UPIN
IN211290AMedicare ID - Type Unspecified