Provider Demographics
NPI:1417074154
Name:MCDANIEL CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:MCDANIEL CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-388-0970
Mailing Address - Street 1:1330 EXCHANGE ST
Mailing Address - Street 2:STE 105
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4425
Mailing Address - Country:US
Mailing Address - Phone:802-388-0970
Mailing Address - Fax:802-388-0917
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:STE 105
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4425
Practice Address - Country:US
Practice Address - Phone:802-388-0970
Practice Address - Fax:802-388-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9154OtherBCBS ID NUMBER
VT9153OtherBCBS ID NUMBER
VTU06408Medicare UPIN
VTVT9934Medicare ID - Type UnspecifiedMEDICARE #
VT9154OtherBCBS ID NUMBER
VTVT9935Medicare ID - Type UnspecifiedMEDICARE #