Provider Demographics
NPI:1104006675
Name:QUALLS, DANIEL JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JASON
Last Name:QUALLS
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:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-0577
Mailing Address - Country:US
Mailing Address - Phone:816-896-0281
Mailing Address - Fax:
Practice Address - Street 1:120 STONEY BROOKE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2160
Practice Address - Country:US
Practice Address - Phone:606-329-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor