Provider Demographics
NPI:1396903217
Name:CHILDS, DANIEL R JR (MASTERS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:CHILDS
Suffix:JR
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 LEMON DROP LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8809
Mailing Address - Country:US
Mailing Address - Phone:859-509-0405
Mailing Address - Fax:
Practice Address - Street 1:449 LEMON DROP LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8809
Practice Address - Country:US
Practice Address - Phone:859-509-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator