Provider Demographics
NPI:1508822818
Name:DANIELS, JERRY H (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:H
Last Name:DANIELS
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 1:628 NW YORK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9732
Mailing Address - Country:US
Mailing Address - Phone:541-383-8988
Mailing Address - Fax:
Practice Address - Street 1:628 NW YORK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9732
Practice Address - Country:US
Practice Address - Phone:541-383-8988
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor