Provider Demographics
NPI:1285888255
Name:DAUER, DAVID R (DC OMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DAUER
Suffix:
Gender:M
Credentials:DC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-0999
Mailing Address - Country:US
Mailing Address - Phone:310-378-9990
Mailing Address - Fax:310-544-2957
Practice Address - Street 1:1102 AVIATION BLVD STE C
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4000
Practice Address - Country:US
Practice Address - Phone:310-378-9990
Practice Address - Fax:310-544-2957
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10708111N00000X
CAAC2645171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist