Provider Demographics
NPI:1841300019
Name:JUNIOR, DANIEL BERNARD III (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BERNARD
Last Name:JUNIOR
Suffix:III
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 1:27 SPRINGBROOK RD W
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9136
Mailing Address - Country:US
Mailing Address - Phone:973-334-5558
Mailing Address - Fax:973-884-3605
Practice Address - Street 1:472 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3064
Practice Address - Country:US
Practice Address - Phone:973-884-1111
Practice Address - Fax:973-884-3605
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ059790Medicare ID - Type Unspecified