Healthcare Provider Details

I. General information

NPI: 1205803780
Provider Name (Legal Business Name): DARYL G DAMRON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N ADELAIDE ST
FENTON MI
48430-2670
US

IV. Provider business mailing address

1345 WILLOWDALE CT B
FLINT MI
48532-4737
US

V. Phone/Fax

Practice location:
  • Phone: 810-629-2245
  • Fax: 810-629-6535
Mailing address:
  • Phone: 810-820-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301006527
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: