Provider Demographics
NPI:1972504892
Name:HALES, DARYL ELDON (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:ELDON
Last Name:HALES
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 1:360 S STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1892
Mailing Address - Country:US
Mailing Address - Phone:801-773-1821
Mailing Address - Fax:801-825-5276
Practice Address - Street 1:360 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1892
Practice Address - Country:US
Practice Address - Phone:801-773-1821
Practice Address - Fax:801-825-5276
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT22-160282-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870333664OtherFEDERAL ID NUMBER
UT19951OtherPEHP PROVIDER ID
UT51658OtherU OF U HEALTH ID
UT35602OtherDMBA PROVIDER ID
UT107001037101OtherSELECT HEALTH PROV. ID
UT10450OtherALTIUS IDENTIFIER
UT870395551HA4OtherEDUCATORS PROVIDER ID
UT000005642Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
UTT78036Medicare UPIN