Provider Demographics
NPI:1710945324
Name:FLAKE, DANIEL S (DC,CCSP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:FLAKE
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S BEELINE HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4892
Mailing Address - Country:US
Mailing Address - Phone:928-474-8417
Mailing Address - Fax:928-474-8417
Practice Address - Street 1:411 S BEELINE HWY
Practice Address - Street 2:SUITE C
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4892
Practice Address - Country:US
Practice Address - Phone:928-474-8417
Practice Address - Fax:928-474-8417
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC3716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120590OtherPTAN
AZ120590OtherPTAN