Provider Demographics
NPI:1619078060
Name:CHERRY, DAVID DANIEL (OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DANIEL
Last Name:CHERRY
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1133 SMITH LN
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4103
Mailing Address - Country:US
Mailing Address - Phone:916-789-1006
Mailing Address - Fax:916-789-8881
Practice Address - Street 1:1133 SMITH LN
Practice Address - Street 2:SUITE 6
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4103
Practice Address - Country:US
Practice Address - Phone:916-789-1006
Practice Address - Fax:916-789-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC2682171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist