Healthcare Provider Details

I. General information

NPI: 1427138304
Provider Name (Legal Business Name): DARYL D WILLS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 VALLEY VIEW DR STE 1300
SCOTTSBLUFF NE
69361-1459
US

IV. Provider business mailing address

416 VALLEY VIEW DR STE 1300
SCOTTSBLUFF NE
69361-1459
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-7176
  • Fax: 308-436-2092
Mailing address:
  • Phone: 308-436-7176
  • Fax: 308-436-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number531
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier09621
Identifier TypeOTHER
Identifier StateNE
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier83023906301
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: