Provider Demographics
NPI:1952466864
Name:LOGAN, DANIEL E (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:LOGAN
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 1:6666 W PEORIA AVE
Mailing Address - Street 2:114
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-7014
Mailing Address - Country:US
Mailing Address - Phone:623-776-2991
Mailing Address - Fax:623-776-0377
Practice Address - Street 1:6666 W PEORIA AVE
Practice Address - Street 2:114
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-7014
Practice Address - Country:US
Practice Address - Phone:623-776-2991
Practice Address - Fax:623-776-0377
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932260OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
AZZ$$$$$$$$$Medicare PIN