Provider Demographics
NPI:1760582043
Name:DANIELS, PAMELA (CH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2922
Mailing Address - Country:US
Mailing Address - Phone:408-292-9765
Mailing Address - Fax:408-292-9766
Practice Address - Street 1:1165 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2922
Practice Address - Country:US
Practice Address - Phone:408-292-9765
Practice Address - Fax:408-292-9766
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0252290Medicare PIN