Provider Demographics
NPI:1538329057
Name:COLE, DARRELL GARRETT (DC)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:GARRETT
Last Name:COLE
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 1:9705 PARKLAND RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2144
Mailing Address - Country:US
Mailing Address - Phone:315-651-3196
Mailing Address - Fax:
Practice Address - Street 1:9705 PARKLAND RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2144
Practice Address - Country:US
Practice Address - Phone:315-651-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor