Provider Demographics
NPI:1417957069
Name:DANZEY, WILLIAM PATRICK (DCPA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:DANZEY
Suffix:
Gender:M
Credentials:DCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 US 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2151
Mailing Address - Country:US
Mailing Address - Phone:863-453-5777
Mailing Address - Fax:863-453-9737
Practice Address - Street 1:1590 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2151
Practice Address - Country:US
Practice Address - Phone:863-453-5777
Practice Address - Fax:863-453-9737
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051172200Medicaid
FL70409Medicare ID - Type Unspecified
FL6178730001Medicare NSC
FL051172200Medicaid