Provider Demographics
NPI:1104037597
Name:MCDANIEL, TONIKA DINEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TONIKA
Middle Name:DINEL
Last Name:MCDANIEL
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 1:1408 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2433
Mailing Address - Country:US
Mailing Address - Phone:310-320-2353
Mailing Address - Fax:310-328-9934
Practice Address - Street 1:1408 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2433
Practice Address - Country:US
Practice Address - Phone:310-320-2353
Practice Address - Fax:310-328-9934
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28579Medicare ID - Type UnspecifiedCHIROPRACTOR