Provider Demographics
NPI:1932135605
Name:AMMONS, DARYL LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:LYNN
Last Name:AMMONS
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 1:1401 GREENWAY CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-6954
Mailing Address - Country:US
Mailing Address - Phone:919-774-6111
Mailing Address - Fax:919-774-9587
Practice Address - Street 1:1401 GREENWAY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6954
Practice Address - Country:US
Practice Address - Phone:919-774-6111
Practice Address - Fax:919-774-9587
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64360Medicare UPIN
NC244300AMedicare ID - Type Unspecified