Provider Demographics
NPI:1881319820
Name:AULT, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:AULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 MAPLE AVE W # 231
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5612
Mailing Address - Country:US
Mailing Address - Phone:703-370-5300
Mailing Address - Fax:703-370-0080
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY STE 301
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-499-8840
Practice Address - Fax:703-499-8842
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor