Provider Demographics
NPI:1366916140
Name:DANIELS, RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:DANIELS
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 1:2155 GREEN VISTA DR
Mailing Address - Street 2:STE 202
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8512
Mailing Address - Country:US
Mailing Address - Phone:775-250-9195
Mailing Address - Fax:
Practice Address - Street 1:2155 GREEN VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8542
Practice Address - Country:US
Practice Address - Phone:775-250-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor