Provider Demographics
NPI:1710467626
Name:DANIEL, DARIN MATHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:MATHEW
Last Name:DANIEL
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 1:1909 REILLY RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1726
Mailing Address - Country:US
Mailing Address - Phone:646-530-1696
Mailing Address - Fax:
Practice Address - Street 1:2216 W PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3318
Practice Address - Country:US
Practice Address - Phone:267-534-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor