MEDICARE: DR. DARYL ELDON HALES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	22-160282-1202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	870333664	OTHER	UT	FEDERAL ID NUMBER
2	19951	OTHER	UT	PEHP PROVIDER ID
3	51658	OTHER	UT	U OF U HEALTH ID
4	35602	OTHER	UT	DMBA PROVIDER ID
5	107001037101	OTHER	UT	SELECT HEALTH PROV. ID
6	10450	OTHER	UT	ALTIUS IDENTIFIER
7	870395551HA4	OTHER	UT	EDUCATORS PROVIDER ID

General Provider Information

NPI Number	:	1972504892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARYL ELDON HALES D.C.

Provider Business Mailing Address
First Line	:	360 S STATE ST
Second Line	:	SUITE A
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1892
Country	:	US
Telephone Number	:	801-773-1821
Fax Number	:	801-825-5276

Provider Business Practice Location Address
First Line	:	360 S STATE ST
Second Line	:	SUITE A
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1892
Country	:	US
Telephone Number	:	801-773-1821
Fax Number	:	801-825-5276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/27/2011

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