Healthcare Provider Details

I. General information

NPI: 1184642092
Provider Name (Legal Business Name): DARCEY RENE WALRAVEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. DARCEY LADNER

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OLD MILL RD
WAXHAW NC
28173-8352
US

IV. Provider business mailing address

301 OLD MILL RD
WAXHAW NC
28173-8352
US

V. Phone/Fax

Practice location:
  • Phone: 704-299-8698
  • Fax:
Mailing address:
  • Phone: 704-299-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3275
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: