Provider Demographics
NPI:1386848745
Name:ILIFF, DANIEL A (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:ILIFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2560 S CLEVELAND AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2641
Mailing Address - Country:US
Mailing Address - Phone:269-983-1800
Mailing Address - Fax:269-983-1801
Practice Address - Street 1:6560 RED ARROW HIGHWAY
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038
Practice Address - Country:US
Practice Address - Phone:269-468-5775
Practice Address - Fax:269-468-3447
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDI009262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDI009262OtherSTATE LISCENSE NUMBER
MI950A101140OtherBLUE CROSS BLUE SHIELD
MI950A101140OtherBLUE CROSS BLUE SHIELD