Healthcare Provider Details

I. General information

NPI: 1700831658
Provider Name (Legal Business Name): DARRELL LEE FYNAARDT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S63W13620 JANESVILLE RD
MUSKEGO WI
53150-2713
US

IV. Provider business mailing address

S63W13620 JANESVILLE RD
MUSKEGO WI
53150-2713
US

V. Phone/Fax

Practice location:
  • Phone: 262-425-9776
  • Fax: 414-425-9794
Mailing address:
  • Phone: 262-679-2060
  • Fax: 414-425-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2492-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: