Provider Demographics
NPI:1215077516
Name:RACE, DANIEL EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:RACE
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 1:4700 N CLOVERDALE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1081
Mailing Address - Country:US
Mailing Address - Phone:208-322-7900
Mailing Address - Fax:208-322-6405
Practice Address - Street 1:4700 N CLOVERDALE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1067
Practice Address - Country:US
Practice Address - Phone:208-322-7900
Practice Address - Fax:208-322-6405
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1233111N00000X
TX10922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor