Provider Demographics
NPI:1700825403
Name:OBREY, DARREN B (DC)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:B
Last Name:OBREY
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 1:211 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1519
Mailing Address - Country:US
Mailing Address - Phone:417-777-4848
Mailing Address - Fax:417-777-3066
Practice Address - Street 1:1200 E WOODHURST DR STE R300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4240
Practice Address - Country:US
Practice Address - Phone:417-877-1300
Practice Address - Fax:174-877-1335
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870686922OtherTAX IDENTIFICATION NUMBER
UT870686922OtherTAX IDENTIFICATION NUMBER