Provider Demographics
NPI:1417112467
Name:DARNELL, TREVOR S (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:S
Last Name:DARNELL
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 1:9995 RAPID CITY RD NW
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49676-8412
Mailing Address - Country:US
Mailing Address - Phone:231-331-7010
Mailing Address - Fax:231-331-7011
Practice Address - Street 1:9995 RAPID CITY RD NW
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:MI
Practice Address - Zip Code:49676-8412
Practice Address - Country:US
Practice Address - Phone:231-331-7010
Practice Address - Fax:231-331-7011
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor