Provider Demographics
NPI:1497988463
Name:DIERDORFF, DANIEL JOE I (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOE
Last Name:DIERDORFF
Suffix:I
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 1:2941 W ANDERSON LN
Mailing Address - Street 2:SUITE 2941
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1125
Mailing Address - Country:US
Mailing Address - Phone:512-419-1367
Mailing Address - Fax:
Practice Address - Street 1:2941 W ANDERSON LN
Practice Address - Street 2:SUITE 2941
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1125
Practice Address - Country:US
Practice Address - Phone:512-419-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor