Provider Demographics
NPI:1922012954
Name:PEWE, DANIEL MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:PEWE
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 1:288 HIGHWAY 16, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2973
Mailing Address - Country:US
Mailing Address - Phone:208-365-2225
Mailing Address - Fax:208-365-2225
Practice Address - Street 1:288 HIGHWAY 16 STE 101
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-5082
Practice Address - Country:US
Practice Address - Phone:208-365-2225
Practice Address - Fax:208-365-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002713900Medicaid
ID002713900Medicaid