Provider Demographics
NPI:1669616033
Name:RAE, DANIEL WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:RAE
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 1:1184 N GILBERT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2476
Mailing Address - Country:US
Mailing Address - Phone:480-390-1962
Mailing Address - Fax:
Practice Address - Street 1:1184 N GILBERT RD STE 100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2476
Practice Address - Country:US
Practice Address - Phone:480-390-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8028111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor