Provider Demographics
NPI:1437159415
Name:DAILEY, LAURA RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:RENEE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:E PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-1851
Mailing Address - Country:US
Mailing Address - Phone:330-426-2700
Mailing Address - Fax:330-426-9133
Practice Address - Street 1:79 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:E PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-1851
Practice Address - Country:US
Practice Address - Phone:330-426-2700
Practice Address - Fax:330-426-9133
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3463111N00000X
PADC009336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2493109Medicaid
OH000000341814OtherANTHEM BCBS
OHU98927Medicare UPIN
OH000000341814OtherANTHEM BCBS