Provider Demographics
NPI:1780990259
Name:SHADRICK, DANIEL LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:SHADRICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 GRANT ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1117
Mailing Address - Country:US
Mailing Address - Phone:303-673-1420
Mailing Address - Fax:303-452-4398
Practice Address - Street 1:11900 GRANT ST STE 220
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1117
Practice Address - Country:US
Practice Address - Phone:303-673-1420
Practice Address - Fax:303-452-4398
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006053213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA2029Medicare PIN