Provider Demographics
NPI:1831620327
Name:DANIELSON, LOGAN JON (DO)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:JON
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 W CENTENNIAL PL
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3135
Mailing Address - Country:US
Mailing Address - Phone:208-249-2678
Mailing Address - Fax:
Practice Address - Street 1:1330 N WASHINGTON ST STE 1080
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2446
Practice Address - Country:US
Practice Address - Phone:509-824-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3961866207QS0010X
WAOP61566334207QS0010X
CA20A20017207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine