Provider Demographics
NPI:1588023089
Name:DARR, JUSTIN P (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:P
Last Name:DARR
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 1:704 S HACKMAN ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1630
Mailing Address - Country:US
Mailing Address - Phone:618-635-2502
Mailing Address - Fax:618-635-2506
Practice Address - Street 1:704 S HACKMAN ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1630
Practice Address - Country:US
Practice Address - Phone:618-635-2502
Practice Address - Fax:618-635-2506
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-012881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor