Provider Demographics
NPI:1124100805
Name:DONALD, DANIEL JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:DONALD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:J
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1010 NORTH 7TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-322-5539
Mailing Address - Fax:318-322-3639
Practice Address - Street 1:1010 NORTH 7TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-322-5539
Practice Address - Fax:318-322-3639
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA664244OtherACN#
LA664244OtherACN#