Provider Demographics
NPI:1710997028
Name:DANIEL, RITA (DC)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-1019
Mailing Address - Country:US
Mailing Address - Phone:706-484-0222
Mailing Address - Fax:
Practice Address - Street 1:119 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-1019
Practice Address - Country:US
Practice Address - Phone:706-484-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00487539AMedicaid
GA35ZCBTK-01Medicare ID - Type UnspecifiedCHIROPRACTIC