Provider Demographics
NPI:1538254123
Name:VETTER, DANNY JOE (DC)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:JOE
Last Name:VETTER
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 1:804 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1607
Mailing Address - Country:US
Mailing Address - Phone:618-806-3349
Mailing Address - Fax:
Practice Address - Street 1:804 AMHERST DR
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-1607
Practice Address - Country:US
Practice Address - Phone:618-806-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006626111N00000X
IL038.006626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038006626Medicaid
IL5982013OtherBLUE CROSS BLUE SHIELD