Provider Demographics
NPI:1588669618
Name:VANDERWEIT, DANIEL MARC (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARC
Last Name:VANDERWEIT
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 1:314 W ROLLINS RD
Mailing Address - Street 2:STE B
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1204
Mailing Address - Country:US
Mailing Address - Phone:847-508-3789
Mailing Address - Fax:
Practice Address - Street 1:314 W ROLLINS RD
Practice Address - Street 2:STE B
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1204
Practice Address - Country:US
Practice Address - Phone:847-508-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5539-12111N00000X
IL038009156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL971760Medicare ID - Type Unspecified
ILK36079Medicare UPIN