Provider Demographics
NPI:1366545048
Name:ELMENHURST, DANIEL DEAN (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DEAN
Last Name:ELMENHURST
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 1:903 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3326
Mailing Address - Country:US
Mailing Address - Phone:509-525-4160
Mailing Address - Fax:509-522-9921
Practice Address - Street 1:903 S HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3326
Practice Address - Country:US
Practice Address - Phone:509-525-4160
Practice Address - Fax:509-522-9921
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000 3109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115118601Medicare ID - Type Unspecified
WAU55854Medicare UPIN