Provider Demographics
NPI:1376715722
Name:DANIELS CHIROPRACTIC OFFICE INC
Entity Type:Organization
Organization Name:DANIELS CHIROPRACTIC OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-638-9999
Mailing Address - Street 1:2609 RAPIDS DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-1741
Mailing Address - Country:US
Mailing Address - Phone:262-638-9999
Mailing Address - Fax:
Practice Address - Street 1:2609 RAPIDS DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-1741
Practice Address - Country:US
Practice Address - Phone:262-638-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2240261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center