Provider Demographics
NPI:1336352186
Name:DANIELS, JOHN WESLEY (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:DANIELS
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 1:1300 BANCROFT AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5147
Mailing Address - Country:US
Mailing Address - Phone:510-351-0628
Mailing Address - Fax:510-351-6054
Practice Address - Street 1:1300 BANCROFT AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-351-0628
Practice Address - Fax:510-351-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15563111NI0013X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC015563Medicare ID - Type Unspecified
CAT05818Medicare UPIN