Provider Demographics
NPI:1457786766
Name:STROM, DANIEL LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEWIS
Last Name:STROM
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 1:10601 KAW DR STE 3-C
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1130
Mailing Address - Country:US
Mailing Address - Phone:337-378-5544
Mailing Address - Fax:
Practice Address - Street 1:10601 KAW DR STE 3-C
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66111-1130
Practice Address - Country:US
Practice Address - Phone:337-378-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor