Basic Information
| Provider Information | |||||||||
| NPI: | 1346668613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALEY | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | CODY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6360 S 3000 E STE 200 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017978000 | ||||||||
| FaxNumber: | 8557693885 | ||||||||
| Practice Location | |||||||||
| Address1: | 6360 S 3000 E STE 200 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017978000 | ||||||||
| FaxNumber: | 8557693885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2014 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 120299501204 | UT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.