Provider Demographics
NPI:1164632444
Name:DAUGHERTY, JOHN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:DAUGHERTY
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 1:1923 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3838
Mailing Address - Country:US
Mailing Address - Phone:719-635-4022
Mailing Address - Fax:719-635-4735
Practice Address - Street 1:1923 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3838
Practice Address - Country:US
Practice Address - Phone:719-635-4022
Practice Address - Fax:719-635-4735
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor