Provider Demographics
NPI:1063561421
Name:REOCH, DARYL W (DC)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:W
Last Name:REOCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S DIVISION AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2737
Mailing Address - Country:US
Mailing Address - Phone:208-263-1661
Mailing Address - Fax:
Practice Address - Street 1:301 S DIVISION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2737
Practice Address - Country:US
Practice Address - Phone:208-263-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor