Provider Demographics
NPI:1184642092
Name:WALRAVEN, DARCEY RENE (DC)
Entity type:Individual
Prefix:DR
First Name:DARCEY
Middle Name:RENE
Last Name:WALRAVEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DARCEY
Other - Middle Name:
Other - Last Name:LADNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8352
Mailing Address - Country:US
Mailing Address - Phone:704-299-8698
Mailing Address - Fax:
Practice Address - Street 1:301 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8352
Practice Address - Country:US
Practice Address - Phone:704-299-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1861264111Medicaid
NC1184642092Medicaid
NC1679068464Medicaid
NC1811485378Medicaid
NC89085UHMedicaid