Healthcare Provider Details

I. General information

NPI: 1457786766
Provider Name (Legal Business Name): DANIEL LEWIS STROM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 KAW DR STE 3-C
EDWARDSVILLE KS
66111-1130
US

IV. Provider business mailing address

10601 KAW DR STE 3-C
EDWARDSVILLE KS
66111-1130
US

V. Phone/Fax

Practice location:
  • Phone: 337-378-5544
  • Fax:
Mailing address:
  • Phone: 337-378-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05566
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: