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General NPI Number Information
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NPI Number | 1831288331
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Entity Type | Individual
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Provider Name | DANIEL W TALLEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 30 ACOMA BLVD S STE 203
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5920
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Country | US
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Telephone | 928-680-9500
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Fax | 928-680-9500
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Provider Business Mailing Address
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Address Line | 1116 KIBBEY DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-2155
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Country | US
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Telephone | 928-855-9605
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Fax | 928-680-9505
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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 | 7202
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License Number State | AZ
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