Provider Demographics
NPI:1225010028
Name:CHEATHAM, DANIEL L (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:CHEATHAM
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 1:106 W MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4713
Mailing Address - Country:US
Mailing Address - Phone:815-434-1616
Mailing Address - Fax:815-434-1625
Practice Address - Street 1:106 W MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4713
Practice Address - Country:US
Practice Address - Phone:815-434-1616
Practice Address - Fax:815-434-1625
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5082014OtherBLUE CROSS/BLUE SHIELD
IL651463OtherUNITED HEALTHCARE ACN
IL791350930OtherRAIL ROAD MEDICARE
IL651463OtherUNITED HEALTHCARE ACN
ILT37236Medicare UPIN