Provider Demographics
NPI:1851414700
Name:DACCARDI, JOHN LEONARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEONARD
Last Name:DACCARDI
Suffix:JR
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 1:2625 EAST SOUTHLAKE BLVD.
Mailing Address - Street 2:STE 120
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-891-1673
Mailing Address - Fax:
Practice Address - Street 1:14300 N NORTHSIGHT BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3677
Practice Address - Country:US
Practice Address - Phone:480-401-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6217111N00000X
MN4543111N00000X
TX11467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor