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General NPI Number Information
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NPI Number | 1215076997
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Entity Type | Individual
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Provider Name | DARRYL ALBERT OBLACK D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 510 BAXTER RD SUITE 4S
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7032
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Country | US
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Telephone | 636-227-6336
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Fax | 636-227-9878
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Provider Business Mailing Address
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Address Line | 510 BAXTER RD SUITE 4S
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7032
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Country | US
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Telephone | 636-227-6336
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Fax | 636-227-9878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CE006385
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License Number State | MO
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