Healthcare Provider Details

I. General information

NPI: 1902462245
Provider Name (Legal Business Name): DANIEL PSALTIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 MARAY DR
ROCKFORD IL
61107-4964
US

IV. Provider business mailing address

4202 MARAY DR
ROCKFORD IL
61107-4964
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: