Provider Demographics
NPI:1194886952
Name:SECREST, DANIEL PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PAUL
Last Name:SECREST
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:3350 N HAYDEN RD
Mailing Address - Street 2:SECREST FAMILY CHIROPRACTICE PC SUITE #112
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-994-4411
Mailing Address - Fax:480-994-4421
Practice Address - Street 1:3350 N HAYDEN RD
Practice Address - Street 2:SECREST FAMILY CHIROPRACTICE PC SUITE #112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-994-4411
Practice Address - Fax:480-994-4421
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7326111N00000X
AZ4010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94786Medicare UPIN
74062Medicare ID - Type Unspecified