Healthcare Provider Details

I. General information

NPI: 1336352186
Provider Name (Legal Business Name): JOHN WESLEY DANIELS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BANCROFT AVE SUITE 104
SAN LEANDRO CA
94577-5147
US

IV. Provider business mailing address

1300 BANCROFT AVE SUITE 104
SAN LEANDRO CA
94577-5147
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-0628
  • Fax: 510-351-6054
Mailing address:
  • Phone: 510-351-0628
  • Fax: 510-351-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number15563
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: