Provider Demographics
NPI:1497222145
Name:GAGNE, DANIELLE (DC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GAGNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SW BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1912
Mailing Address - Country:US
Mailing Address - Phone:772-380-3264
Mailing Address - Fax:
Practice Address - Street 1:1803 S AUSTRALIAN AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6454
Practice Address - Country:US
Practice Address - Phone:561-207-2077
Practice Address - Fax:561-584-7031
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05292111N00000X
FL12637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107819900Medicaid