Provider Demographics
NPI:1295724219
Name:NETZ, DARRELL W (DC)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:W
Last Name:NETZ
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:PO BOX 956
Mailing Address - Street 2:502 E CHEROKEE AVE
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-0956
Mailing Address - Country:US
Mailing Address - Phone:918-775-7100
Mailing Address - Fax:918-775-7138
Practice Address - Street 1:502 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4842
Practice Address - Country:US
Practice Address - Phone:918-775-7100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20050081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U34124Medicare UPIN