Provider Demographics
NPI:1629189857
Name:SONG, DANNY (DC)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:
Last Name:SONG
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 1:5348 CARROLL CANYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1733
Mailing Address - Country:US
Mailing Address - Phone:858-202-1546
Mailing Address - Fax:858-202-1548
Practice Address - Street 1:5348 CARROLL CANYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1733
Practice Address - Country:US
Practice Address - Phone:858-202-1546
Practice Address - Fax:858-202-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28175111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28175Medicare ID - Type UnspecifiedCHIROPRACTIC