Provider Demographics
NPI:1417984170
Name:BANCROFT, DANIEL M (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:BANCROFT
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 1:1225 S MAIN ST
Mailing Address - Street 2:STE 304C
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5370
Mailing Address - Country:US
Mailing Address - Phone:724-837-6234
Mailing Address - Fax:
Practice Address - Street 1:1225 S MAIN ST
Practice Address - Street 2:STE 304C
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5370
Practice Address - Country:US
Practice Address - Phone:724-837-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007059-L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA975823OtherHIGHMARK BC/BS PROV ID
PAU67592Medicare UPIN
PA975823OtherHIGHMARK BC/BS PROV ID