Provider Demographics
NPI:1831120138
Name:DALY, DAVID GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
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 1:2708 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171100000X
FLCH 7728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL648551OtherUNITED HEALTHCARE
FL5979392OtherCIGNA
FL381260000Medicaid
FL350050933OtherRAILROAD MEDICARE
FL55952OtherBCBS
FL350050933OtherRAILROAD MEDICARE
U79241Medicare UPIN