Provider Demographics
NPI:1558445296
Name:MULDAVIN, DANIEL BURTON (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BURTON
Last Name:MULDAVIN
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 1:2801 Q ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6912
Mailing Address - Country:US
Mailing Address - Phone:916-455-5404
Mailing Address - Fax:916-455-2154
Practice Address - Street 1:2801 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6912
Practice Address - Country:US
Practice Address - Phone:916-455-5404
Practice Address - Fax:916-455-2154
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0192250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0192250Medicare ID - Type Unspecified