Provider Demographics
NPI:1780694448
Name:COHEN, DANIEL J (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:COHEN
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 1:711 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3625
Mailing Address - Country:US
Mailing Address - Phone:866-601-4443
Mailing Address - Fax:866-596-6056
Practice Address - Street 1:711 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3625
Practice Address - Country:US
Practice Address - Phone:866-601-4443
Practice Address - Fax:866-596-6056
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
202439500OtherUSDOL
VA8939896Medicaid
202439500OtherUSDOL