Provider Demographics
NPI:1649263567
Name:DANIELI, BARRY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ROBERT
Last Name:DANIELI
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:EL VERANO
Mailing Address - State:CA
Mailing Address - Zip Code:95433-0190
Mailing Address - Country:US
Mailing Address - Phone:707-996-2252
Mailing Address - Fax:707-935-6539
Practice Address - Street 1:19016 BAY ST.
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476
Practice Address - Country:US
Practice Address - Phone:707-996-2252
Practice Address - Fax:707-935-6539
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3801320OtherFED. TAX ID#
CA95-3801320OtherFED. TAX ID#