Provider Demographics
NPI:1790847713
Name:COHEN, DANIEL GUSTAVO (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GUSTAVO
Last Name:COHEN
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 1:1810 STATE ROAD 436
Mailing Address - Street 2:# 104
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2238
Mailing Address - Country:US
Mailing Address - Phone:407-672-1616
Mailing Address - Fax:407-672-0613
Practice Address - Street 1:1810 STATE ROAD 436
Practice Address - Street 2:# 104
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2238
Practice Address - Country:US
Practice Address - Phone:407-672-1616
Practice Address - Fax:407-672-0613
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXOY961OtherBLUE CROSS BLUE SHIELD
FL317242OtherCHIRO ALLIANCE CORP.
FL9902787OtherCIGNA
FL7654022OtherAETNA
FL9902787OtherCIGNA
FL317242OtherCHIRO ALLIANCE CORP.
FL55274XMedicare ID - Type Unspecified