Provider Demographics
NPI:1215008834
Name:DESJARDINS, DANIEL LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEONARD
Last Name:DESJARDINS
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 1:3314 NE TILLICUM
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7485
Mailing Address - Country:US
Mailing Address - Phone:503-666-2298
Mailing Address - Fax:
Practice Address - Street 1:3314 NE TILLICUM
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7485
Practice Address - Country:US
Practice Address - Phone:036-662-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1059020OtherASH DOC ID
1326211673OtherGROUP NPI
OR1059020OtherASH DOC ID
OR93-1309894OtherFEDERAL TAX ID NUMBER