Provider Demographics
NPI:1861631574
Name:MALDONADO, DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MALDONADO
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 1:8820 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49271-9782
Mailing Address - Country:US
Mailing Address - Phone:760-468-1958
Mailing Address - Fax:
Practice Address - Street 1:8820 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:MI
Practice Address - Zip Code:49271-9782
Practice Address - Country:US
Practice Address - Phone:760-468-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31130111N00000X
NVB01446111N00000X
MI2301010192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor