Provider Demographics
NPI:1063552065
Name:DEAREY, DANIELLE CHRISTINA (DC)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:CHRISTINA
Last Name:DEAREY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NE LECHNER ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2445
Mailing Address - Country:US
Mailing Address - Phone:360-835-3527
Mailing Address - Fax:360-835-3528
Practice Address - Street 1:331 NE LECHNER ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2445
Practice Address - Country:US
Practice Address - Phone:360-835-3527
Practice Address - Fax:360-835-3528
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU90128Medicare UPIN
WAGAB40258Medicare PIN