Provider Demographics
NPI:1598825614
Name:METCALF, DARRELL K (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:K
Last Name:METCALF
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 1:304 4TH AVE NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1236
Mailing Address - Country:US
Mailing Address - Phone:320-251-0766
Mailing Address - Fax:320-251-8295
Practice Address - Street 1:304 4TH AVE NE
Practice Address - Street 2:SUITE 3
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1236
Practice Address - Country:US
Practice Address - Phone:320-251-0766
Practice Address - Fax:320-251-8295
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51F36COOtherBCBS GROUP NUMBER
MN51F37MEOtherBCBS PERSONAL ID