Provider Demographics
NPI:1275863938
Name:COCKRELL, DANIEL ROSS (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROSS
Last Name:COCKRELL
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 1:665 NEW YORK RANCH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9331
Mailing Address - Country:US
Mailing Address - Phone:209-223-2225
Mailing Address - Fax:209-223-2976
Practice Address - Street 1:60 RIDGE RD G
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4288
Practice Address - Country:US
Practice Address - Phone:209-267-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor