Provider Demographics
NPI:1346212099
Name:SODERHOLM, DANIEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:SODERHOLM
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 1:2205 N SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3310
Mailing Address - Country:US
Mailing Address - Phone:608-244-0044
Mailing Address - Fax:
Practice Address - Street 1:2205 N SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3310
Practice Address - Country:US
Practice Address - Phone:608-244-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391545009014OtherBCBS
WI391545009OtherTAX ID
WI38777500Medicaid
WI391545009OtherTAX ID
WI38777500Medicaid