Provider Demographics
NPI:1619037652
Name:COOGAN, DANIEL LEROY (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEROY
Last Name:COOGAN
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 1:235 JUNGERMANN RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5364
Mailing Address - Country:US
Mailing Address - Phone:636-928-7387
Mailing Address - Fax:636-928-1269
Practice Address - Street 1:235 JUNGERMANN RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5364
Practice Address - Country:US
Practice Address - Phone:636-928-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO289020OtherGHP
MO4409509OtherUHC
MO6593160002OtherCIGNA
MO756872206Medicaid
MO0192OtherGATEWAY EDI
MO109583OtherHEALTHLINK
MO19328OtherABCBS
MO4409509OtherUHC
MO31136Medicare ID - Type Unspecified