Provider Demographics
NPI:1649505462
Name:DANIELS, ERIC J (BA, BS, DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:DANIELS
Suffix:
Gender:M
Credentials:BA, BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 VIKING BLVD NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MN
Mailing Address - Zip Code:55011-9339
Mailing Address - Country:US
Mailing Address - Phone:763-753-0993
Mailing Address - Fax:763-753-0994
Practice Address - Street 1:3158 VIKING BLVD NW
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MN
Practice Address - Zip Code:55011-9339
Practice Address - Country:US
Practice Address - Phone:763-753-0993
Practice Address - Fax:763-753-0994
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor