Provider Demographics
NPI:1013099308
Name:PRINCE, DANIEL JOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOEL
Last Name:PRINCE
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 1:2537 S. KELLY AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3878
Mailing Address - Country:US
Mailing Address - Phone:405-757-2079
Mailing Address - Fax:
Practice Address - Street 1:2537 S. KELLY AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3878
Practice Address - Country:US
Practice Address - Phone:405-757-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4050111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor