Provider Demographics
NPI:1992876775
Name:RIES, DARREL RAY (DC)
Entity type:Individual
Prefix:DR
First Name:DARREL
Middle Name:RAY
Last Name:RIES
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 1:711 NE IRVING AVE.
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4738
Mailing Address - Country:US
Mailing Address - Phone:541-388-0496
Mailing Address - Fax:541-617-3917
Practice Address - Street 1:711 NE IRVING AVE.
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4738
Practice Address - Country:US
Practice Address - Phone:541-388-0496
Practice Address - Fax:541-617-3917
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT60855Medicare UPIN
ORR0000QGCLCMedicare ID - Type Unspecified