Provider Demographics
NPI:1326030180
Name:NEISES, DANIEL W (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:NEISES
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 1:2512 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-4735
Mailing Address - Country:US
Mailing Address - Phone:309-786-3012
Mailing Address - Fax:309-786-7272
Practice Address - Street 1:2512 18TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-4735
Practice Address - Country:US
Practice Address - Phone:309-786-3012
Practice Address - Fax:309-786-7272
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38943600Medicaid
WI38943600Medicaid
WIU89896Medicare UPIN