Provider Demographics
NPI:1376826164
Name:FANNEY, DARYN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYN
Middle Name:
Last Name:FANNEY
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 1:5151 SE HOLGATE BLVD APT 312
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3887
Mailing Address - Country:US
Mailing Address - Phone:407-616-1982
Mailing Address - Fax:
Practice Address - Street 1:2505 SW SPRING GARDEN ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3966
Practice Address - Country:US
Practice Address - Phone:503-841-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6137111N00000X
FLCH10331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor