Provider Demographics
NPI:1487649612
Name:DALY, KEVIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:DALY
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 1:44 ADAMS ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1936
Mailing Address - Country:US
Mailing Address - Phone:617-479-1434
Mailing Address - Fax:
Practice Address - Street 1:44 ADAMS ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1936
Practice Address - Country:US
Practice Address - Phone:617-479-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADA Y35-898Medicare UPIN