Provider Demographics
NPI:1043386733
Name:COHEN, DANIEL BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRUCE
Last Name:COHEN
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 1:31390 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE C.
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2561
Mailing Address - Country:US
Mailing Address - Phone:248-855-2666
Mailing Address - Fax:248-855-6460
Practice Address - Street 1:31390 NORTHWESTERN HWY
Practice Address - Street 2:SUITE C.
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2561
Practice Address - Country:US
Practice Address - Phone:248-855-2666
Practice Address - Fax:248-855-6460
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F335790OtherBLUE CROSS PIN
MIU39892Medicare UPIN