Provider Demographics
NPI:1366444077
Name:NIEQUIST, DAN ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ARTHUR
Last Name:NIEQUIST
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 1:1126 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3482
Mailing Address - Country:US
Mailing Address - Phone:847-658-8514
Mailing Address - Fax:847-658-8515
Practice Address - Street 1:1126 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3482
Practice Address - Country:US
Practice Address - Phone:847-658-8514
Practice Address - Fax:847-658-8515
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38003530111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05627052OtherBLUE CROSS AND BLUE SHIEL
IL05627052OtherBLUE CROSS AND BLUE SHIEL