Provider Demographics
NPI:1659704419
Name:BACON, DANIEL DAVIS
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVIS
Last Name:BACON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S CARSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5239
Mailing Address - Country:US
Mailing Address - Phone:775-461-0551
Mailing Address - Fax:
Practice Address - Street 1:701 S CARSON ST STE 200
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5239
Practice Address - Country:US
Practice Address - Phone:775-461-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner