Provider Demographics
NPI:1861421703
Name:PACKARD, DALLAN R (DC)
Entity type:Individual
Prefix:
First Name:DALLAN
Middle Name:R
Last Name:PACKARD
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 1:10988 COMBIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8987
Mailing Address - Country:US
Mailing Address - Phone:530-268-1386
Mailing Address - Fax:
Practice Address - Street 1:10988 COMBIE RD STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8987
Practice Address - Country:US
Practice Address - Phone:530-268-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056381Medicare PIN
WA900508181OtherTAX ID #