Provider Demographics
NPI:1528188943
Name:AXELROD, DANIEL HOWARD (LAC, MACOM, DIPLAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:HOWARD
Last Name:AXELROD
Suffix:
Gender:M
Credentials:LAC, MACOM, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1923
Mailing Address - Country:US
Mailing Address - Phone:720-485-0434
Mailing Address - Fax:
Practice Address - Street 1:2202 JUNIPER CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1923
Practice Address - Country:US
Practice Address - Phone:720-485-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000772171100000X
COACU.0001915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist