Provider Demographics
NPI:1891996245
Name:POUPARD, DANIEL W (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:POUPARD
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 1:2015 NORTH DOBSON ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2295
Mailing Address - Country:US
Mailing Address - Phone:480-821-8855
Mailing Address - Fax:
Practice Address - Street 1:2015 NORTH DOBSON ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2295
Practice Address - Country:US
Practice Address - Phone:480-821-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ5358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC5358Medicare ID - Type Unspecified