Provider Demographics
NPI:1922044619
Name:DANIEL, CARL JAMIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JAMIE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:441 PINEY FOREST RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4154
Mailing Address - Country:US
Mailing Address - Phone:434-793-0700
Mailing Address - Fax:434-793-9315
Practice Address - Street 1:2276 FRANKLIN TPKE
Practice Address - Street 2:SUITE 115
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5284
Practice Address - Country:US
Practice Address - Phone:434-483-8118
Practice Address - Fax:434-234-0263
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010140463Medicaid
C05545OtherGROUP PTAN
6083240001Medicare NSC
006665C45Medicare PIN
VAV03840Medicare UPIN