Provider Demographics
NPI:1740274430
Name:LANEY, DARYL GENE (DC)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:GENE
Last Name:LANEY
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 1:950 EAST HIGHWAY 114
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-380-4183
Mailing Address - Fax:
Practice Address - Street 1:950 EAST HIGHWAY 114
Practice Address - Street 2:SUITE 160
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-380-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00312ZMedicare PIN
TX8F0854Medicare PIN
TXU14234Medicare UPIN