Provider Demographics
NPI:1568512937
Name:CHAMBERLAIN, DANIEL IVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IVAN
Last Name:CHAMBERLAIN
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 1:3839 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12885-1400
Mailing Address - Country:US
Mailing Address - Phone:518-623-4878
Mailing Address - Fax:518-623-3666
Practice Address - Street 1:3839 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:NY
Practice Address - Zip Code:12885-1400
Practice Address - Country:US
Practice Address - Phone:518-623-4878
Practice Address - Fax:518-623-3666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006290-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU-09857Medicare UPIN
NY52450BMedicare ID - Type UnspecifiedMEDICARE