Provider Demographics
NPI:1912092099
Name:DESHONG, DANIEL F JR (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:F
Last Name:DESHONG
Suffix:JR
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 1:4362 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4107
Mailing Address - Country:US
Mailing Address - Phone:916-481-6828
Mailing Address - Fax:916-481-6830
Practice Address - Street 1:4362 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4107
Practice Address - Country:US
Practice Address - Phone:916-481-6828
Practice Address - Fax:916-481-6830
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0111870Medicare ID - Type Unspecified