Provider Demographics
NPI:1952475618
Name:ROUNDY, DARRYL W (DC)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:W
Last Name:ROUNDY
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 1:2310 MILDRED ST W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6036
Mailing Address - Country:US
Mailing Address - Phone:253-460-4244
Mailing Address - Fax:877-841-5137
Practice Address - Street 1:2310 MILDRED ST W # 130
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6036
Practice Address - Country:US
Practice Address - Phone:253-460-4244
Practice Address - Fax:877-841-5137
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000003078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873892Medicare PIN
WAU58372Medicare UPIN