Provider Demographics
NPI:1831288331
Name:TALLEY, DANIEL W (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:TALLEY
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 1:1116 KIBBEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-2155
Mailing Address - Country:US
Mailing Address - Phone:928-855-9605
Mailing Address - Fax:928-680-9505
Practice Address - Street 1:30 ACOMA BLVD S STE 203
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5920
Practice Address - Country:US
Practice Address - Phone:928-680-9500
Practice Address - Fax:928-680-9500
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU90887Medicare UPIN
AZ78494Medicare ID - Type UnspecifiedPROVIDER NUMBER MEDICARE
AZZ78492Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER