Provider Demographics
NPI:1407266117
Name:DANIELSON, JACOB NEPHI (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:NEPHI
Last Name:DANIELSON
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 1:6440 N DURANGO DR BLDG B
Mailing Address - Street 2:SUITE 148
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-8513
Mailing Address - Country:US
Mailing Address - Phone:510-731-7453
Mailing Address - Fax:
Practice Address - Street 1:6440 N DURANGO DR BLDG B
Practice Address - Street 2:SUITE 148
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-8513
Practice Address - Country:US
Practice Address - Phone:510-731-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor