Provider Demographics
NPI:1205803780
Name:DAMRON, DARYL G (DC)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:G
Last Name:DAMRON
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 1:1345 WILLOWDALE CT B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4737
Mailing Address - Country:US
Mailing Address - Phone:810-820-6311
Mailing Address - Fax:
Practice Address - Street 1:102 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2670
Practice Address - Country:US
Practice Address - Phone:810-629-2245
Practice Address - Fax:810-629-6535
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006527111N00000X
MI5601003439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB55077OtherBCBS ID
MI1002998OtherMCLAREN HEALTH PLAN ID
MI950B55077OtherHEALTHPLUS ID
MIP60609OtherBCN ID
MI1935260Medicaid
MIP00000552OtherTRAVELERS
MI950B55077OtherHEALTHPLUS ID
MIOB55077OtherBCBS ID
MI1935260Medicaid