Provider Demographics
NPI:1699799866
Name:DANIEL, JACK M (MAC(UK), LAC)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MAC(UK), LAC
Other - Prefix:
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Mailing Address - Street 1:6730 WESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1717
Mailing Address - Country:US
Mailing Address - Phone:410-948-6615
Mailing Address - Fax:410-764-0583
Practice Address - Street 1:6730 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1717
Practice Address - Country:US
Practice Address - Phone:410-948-6615
Practice Address - Fax:410-764-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00320171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist