Provider Demographics
NPI:1770603318
Name:CROSS, DANIEL A (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:CROSS
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 1:5330 PRIMROSE DR
Mailing Address - Street 2:SUITE # 140
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3520
Mailing Address - Country:US
Mailing Address - Phone:916-967-7436
Mailing Address - Fax:916-967-7456
Practice Address - Street 1:5330 PRIMROSE DR
Practice Address - Street 2:SUITE # 140
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3520
Practice Address - Country:US
Practice Address - Phone:916-967-7436
Practice Address - Fax:916-967-7456
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05431Medicare UPIN
CADC0145810Medicare ID - Type Unspecified