Healthcare Provider Details

I. General information

NPI: 1265459713
Provider Name (Legal Business Name): DANIEL E VINCENT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W TEFFT ST.
NIPOMO CA
93444
US

IV. Provider business mailing address

440 W TEFFT ST.
NIPOMO CA
93444
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-1650
  • Fax: 805-929-8066
Mailing address:
  • Phone: 805-929-1650
  • Fax: 805-929-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14267
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier913324
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerDEPT. OF INDUSTRIAL REL.

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: