Healthcare Provider Details

I. General information

NPI: 1972504892
Provider Name (Legal Business Name): DARYL ELDON HALES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S STATE ST SUITE A
CLEARFIELD UT
84015-1892
US

IV. Provider business mailing address

360 S STATE ST SUITE A
CLEARFIELD UT
84015-1892
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-1821
  • Fax: 801-825-5276
Mailing address:
  • Phone: 801-773-1821
  • Fax: 801-825-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22-160282-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: