Provider Demographics
NPI:1881728707
Name:WEST, DANIEL T (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:WEST
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 1:4607 DIVISION HWY
Mailing Address - Street 2:
Mailing Address - City:EAST EARL
Mailing Address - State:PA
Mailing Address - Zip Code:17519-9245
Mailing Address - Country:US
Mailing Address - Phone:717-354-2332
Mailing Address - Fax:717-355-5253
Practice Address - Street 1:4607 DIVISION HWY
Practice Address - Street 2:
Practice Address - City:EAST EARL
Practice Address - State:PA
Practice Address - Zip Code:17519-9245
Practice Address - Country:US
Practice Address - Phone:717-354-2332
Practice Address - Fax:717-355-5253
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-0038100111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA541292Medicare ID - Type Unspecified
PAU11414Medicare UPIN