Provider Demographics
NPI:1083650220
Name:LAI, DANIEL C (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:LAI
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 1:837 FULFORD CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3816
Mailing Address - Country:US
Mailing Address - Phone:626-757-3173
Mailing Address - Fax:
Practice Address - Street 1:6330 SPRING MOUNTAIN RD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8843
Practice Address - Country:US
Practice Address - Phone:702-873-2261
Practice Address - Fax:702-873-2267
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02007111N00000X
CADC 27250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor