Provider Demographics
NPI:1972627479
Name:LINDELL, DARRYL G
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:G
Last Name:LINDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3632
Mailing Address - Country:US
Mailing Address - Phone:716-668-8021
Mailing Address - Fax:716-668-8022
Practice Address - Street 1:928 FRENCH RD BLDG A
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3632
Practice Address - Country:US
Practice Address - Phone:716-668-8021
Practice Address - Fax:716-668-8022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV08265Medicare UPIN
NYIA0912Medicare PIN