Provider Demographics
NPI:1649275066
Name:STAIGHT, DANIEL ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:STAIGHT
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 1:223 S KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3030
Mailing Address - Country:US
Mailing Address - Phone:307-237-7898
Mailing Address - Fax:307-265-3695
Practice Address - Street 1:223 S KENWOOD ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3030
Practice Address - Country:US
Practice Address - Phone:307-237-7898
Practice Address - Fax:307-265-3695
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY306111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118403200Medicaid
WYW302611Medicare ID - Type Unspecified
WYT44183Medicare UPIN