Provider Demographics
NPI:1134264112
Name:MCDANIELS, DAVID BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENJAMIN
Last Name:MCDANIELS
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 1:2813 COFFEE RD
Mailing Address - Street 2:STE. F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1755
Mailing Address - Country:US
Mailing Address - Phone:209-571-1999
Mailing Address - Fax:209-571-1968
Practice Address - Street 1:2813 COFFEE RD
Practice Address - Street 2:STE. F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1755
Practice Address - Country:US
Practice Address - Phone:209-571-1999
Practice Address - Fax:209-571-1968
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC013605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0136050Medicare ID - Type Unspecified