Provider Demographics
NPI:1215004700
Name:COULTER, DANIELLE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:RENEE
Last Name:COULTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RENEE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2621
Mailing Address - Country:US
Mailing Address - Phone:401-847-4224
Mailing Address - Fax:401-847-6610
Practice Address - Street 1:4 CALVERT ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2621
Practice Address - Country:US
Practice Address - Phone:401-847-4224
Practice Address - Fax:401-847-6610
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU91447Medicare UPIN