Provider Demographics
NPI:1609062934
Name:DALY CHIROPRACTIC & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:DALY CHIROPRACTIC & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PVTS
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-267-4324
Mailing Address - Street 1:2708 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3120
Mailing Address - Country:US
Mailing Address - Phone:321-267-4324
Mailing Address - Fax:321-267-7908
Practice Address - Street 1:2708 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3120
Practice Address - Country:US
Practice Address - Phone:321-267-4324
Practice Address - Fax:321-267-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1516Medicare PIN
FLU79241Medicare UPIN