Provider Demographics
NPI:1528140589
Name:JOHNSON, DANIEL ROBERT (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:JOHNSON
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 1:529 FRENCH ROAD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3438
Mailing Address - Country:US
Mailing Address - Phone:716-674-7246
Mailing Address - Fax:716-674-7247
Practice Address - Street 1:529 FRENCH ROAD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3438
Practice Address - Country:US
Practice Address - Phone:716-674-7246
Practice Address - Fax:716-674-7247
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085331Medicare ID - Type Unspecified