Provider Demographics
NPI:1659450740
Name:UPTON, DANIEL LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LAWRENCE
Last Name:UPTON
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 1:415 N. BROADWAY AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-1637
Mailing Address - Country:US
Mailing Address - Phone:406-446-4433
Mailing Address - Fax:406-446-4433
Practice Address - Street 1:415 N. BROADWAY AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-1637
Practice Address - Country:US
Practice Address - Phone:406-446-4433
Practice Address - Fax:406-446-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT61-1423592OtherFEDERAL TAX ID
MT61-1423592OtherFEDERAL TAX ID