Provider Demographics
NPI:1740306323
Name:CLODFELTER, DANIEL SCOTT (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
Last Name:CLODFELTER
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 1:19501 E US HIGHWAY 40 STE B
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5475
Mailing Address - Country:US
Mailing Address - Phone:816-795-5000
Mailing Address - Fax:816-795-5001
Practice Address - Street 1:19501 E US HIGHWAY 40 STE B
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5475
Practice Address - Country:US
Practice Address - Phone:816-795-5000
Practice Address - Fax:816-795-5001
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24737115OtherBCBS KC
MO24737115OtherBCBS KC