Provider Demographics
NPI:1528156973
Name:DANIEL, NOAH RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:RICHARD
Last Name:DANIEL
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 1:3687 TAMPA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-6307
Mailing Address - Country:US
Mailing Address - Phone:813-310-6123
Mailing Address - Fax:
Practice Address - Street 1:3687 TAMPA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6307
Practice Address - Country:US
Practice Address - Phone:813-310-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8383111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU94732Medicare UPIN