Provider Demographics
NPI:1215959572
Name:RICH, DARYL CURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:CURTIS
Last Name:RICH
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 1:16 W CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-2002
Mailing Address - Country:US
Mailing Address - Phone:540-344-1055
Mailing Address - Fax:540-344-7964
Practice Address - Street 1:16 CHURCH AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-2002
Practice Address - Country:US
Practice Address - Phone:540-344-1055
Practice Address - Fax:540-344-7964
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA185516OtherANTHEM BLUE CROSS
VA0104556233OtherOTHER
VA7046529OtherAETNA
VA313859OtherSOUTHERN HEALTH
VA006786O88Medicare ID - Type Unspecified
VAP004588273Medicare PIN