Provider Demographics
NPI:1225483399
Name:WESTRICK, DANIEL JACOB I
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JACOB
Last Name:WESTRICK
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-3938
Mailing Address - Country:US
Mailing Address - Phone:586-914-4423
Mailing Address - Fax:
Practice Address - Street 1:8644 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-3938
Practice Address - Country:US
Practice Address - Phone:586-914-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIW236135356381390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program