Provider Demographics
NPI:1255422044
Name:MCDANIEL, JOHN WESLEY
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W EL CAMINO REAL STE 4
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1632
Mailing Address - Country:US
Mailing Address - Phone:650-967-1152
Mailing Address - Fax:650-967-5328
Practice Address - Street 1:2290 W EL CAMINO REAL STE 4
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1632
Practice Address - Country:US
Practice Address - Phone:650-967-1152
Practice Address - Fax:650-967-5328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18098111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX45789Medicare UPIN
CADC0180890Medicare ID - Type Unspecified