Provider Demographics
NPI:1588795918
Name:STROUP, DANIEL L (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:STROUP
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 1:110 W SMILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-2130
Mailing Address - Country:US
Mailing Address - Phone:419-342-6000
Mailing Address - Fax:419-342-6002
Practice Address - Street 1:110 W SMILEY AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-2130
Practice Address - Country:US
Practice Address - Phone:419-342-6000
Practice Address - Fax:419-342-6002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2765502Medicaid
OH46-1261658OtherTAX IDENTIFICATION
OH34-1444686OtherTAX IDENTIFICATION
OH2765502Medicaid
OH0842361Medicare PIN