Provider Demographics
NPI:1700885118
Name:KILLIAN, DAN P (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:P
Last Name:KILLIAN
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 1:1720 DOLPHIN CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1429
Mailing Address - Country:US
Mailing Address - Phone:262-547-7441
Mailing Address - Fax:262-547-1971
Practice Address - Street 1:1720 DOLPHIN CT
Practice Address - Street 2:SUITE E
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1429
Practice Address - Country:US
Practice Address - Phone:262-547-7441
Practice Address - Fax:262-547-1971
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70200Medicare ID - Type Unspecified
WI70200Medicare UPIN