Provider Demographics
NPI:1417950999
Name:FERN, HOWARD DARYL (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:DARYL
Last Name:FERN
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 1:201 W GUADALUPE RD STE 311
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3319
Mailing Address - Country:US
Mailing Address - Phone:480-649-5868
Mailing Address - Fax:480-649-5870
Practice Address - Street 1:201 W GUADALUPE RD STE 311
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3319
Practice Address - Country:US
Practice Address - Phone:480-649-5868
Practice Address - Fax:480-649-5870
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU59217Medicare UPIN