Provider Demographics
NPI:1215057344
Name:DEBOER, DANIEL A (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:DEBOER
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 1:2433 ONTARIO ST STE B
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2700
Mailing Address - Country:US
Mailing Address - Phone:708-895-1798
Mailing Address - Fax:
Practice Address - Street 1:2433 ONTARIO ST STE B
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2700
Practice Address - Country:US
Practice Address - Phone:708-895-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008216111N00000X
IN08001736A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRR350043820OtherRAILROAD MEDICARE
IL01622471OtherBLUECROSSBLUESHIELD
IL477360Medicare ID - Type Unspecified