Provider Demographics
NPI:1134870223
Name:DALEY, DOUG (DC)
Entity type:Individual
Prefix:DR
First Name:DOUG
Middle Name:
Last Name:DALEY
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 1:46434 JONATHAN CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3844
Mailing Address - Country:US
Mailing Address - Phone:248-425-2869
Mailing Address - Fax:
Practice Address - Street 1:115 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2011
Practice Address - Country:US
Practice Address - Phone:248-923-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor