Provider Demographics
NPI:1265459713
Name:VINCENT, DANIEL E (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:VINCENT
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 1:440 W TEFFT ST.
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444
Mailing Address - Country:US
Mailing Address - Phone:805-929-1650
Mailing Address - Fax:805-929-8066
Practice Address - Street 1:440 W TEFFT ST.
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444
Practice Address - Country:US
Practice Address - Phone:805-929-1650
Practice Address - Fax:805-929-8066
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA913324OtherDEPT. OF INDUSTRIAL REL.
T05299Medicare UPIN
CADC14267Medicare ID - Type Unspecified