MEDICARE: DR. DANIEL W TALLEY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7202	AZ

General Provider Information

NPI Number	:	1831288331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL W TALLEY D.C.

Provider Business Mailing Address
First Line	:	1116 KIBBEY DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-2155
Country	:	US
Telephone Number	:	928-855-9605
Fax Number	:	928-680-9505

Provider Business Practice Location Address
First Line	:	30 ACOMA BLVD S STE 203
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5920
Country	:	US
Telephone Number	:	928-680-9500
Fax Number	:	928-680-9500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/26/2021

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