Provider Demographics
NPI:1851335095
Name:HOMAN, DARRELL ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:ALLEN
Last Name:HOMAN
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 1:4380 GLEN ESTE WITHAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245
Mailing Address - Country:US
Mailing Address - Phone:513-753-6325
Mailing Address - Fax:513-753-6320
Practice Address - Street 1:4380 GLEN ESTE WITHAMSVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245
Practice Address - Country:US
Practice Address - Phone:513-753-6325
Practice Address - Fax:513-753-6320
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHO9352931Medicare ID - Type Unspecified