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General NPI Number Information
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NPI Number | 1376826164
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Entity Type | Individual
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Provider Name | DARYN FANNEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 2505 SW SPRING GARDEN ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97219-3966
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Country | US
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Telephone | 503-841-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 SE HOLGATE BLVD APT 312
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City | PORTLAND
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State | OR
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Zip | 97206-3887
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Country | US
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Telephone | 407-616-1982
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Fax |
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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 | 6137
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH10331
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License Number State | FL
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