Provider Demographics
NPI:1962586685
Name:VELLIQUETTE, DANIEL VERN (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VERN
Last Name:VELLIQUETTE
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 1:971 CHESTNUT HILLS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814
Mailing Address - Country:US
Mailing Address - Phone:260-625-6511
Mailing Address - Fax:260-625-6711
Practice Address - Street 1:971 CHESTNUT HILLS PARKWAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814
Practice Address - Country:US
Practice Address - Phone:260-625-6511
Practice Address - Fax:260-625-6711
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002059A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83344Medicare UPIN
IN207290AMedicare PIN