Healthcare Provider Details

I. General information

NPI: 1417112467
Provider Name (Legal Business Name): TREVOR S DARNELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9995 RAPID CITY RD NW
RAPID CITY MI
49676-8412
US

IV. Provider business mailing address

9995 RAPID CITY RD NW
RAPID CITY MI
49676-8412
US

V. Phone/Fax

Practice location:
  • Phone: 231-331-7010
  • Fax: 231-331-7011
Mailing address:
  • Phone: 231-331-7010
  • Fax: 231-331-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: