Provider Demographics
NPI:1417302076
Name:HORTON, DANIELLE (LAC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3016
Mailing Address - Country:US
Mailing Address - Phone:409-420-2616
Mailing Address - Fax:
Practice Address - Street 1:316 COLLIER ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-3016
Practice Address - Country:US
Practice Address - Phone:409-420-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist