Healthcare Provider Details

I. General information

NPI: 1790844777
Provider Name (Legal Business Name): DANIEL BRAINUM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 WASHINGTON VALLEY RD
MARTINSVILLE NJ
08836-2026
US

IV. Provider business mailing address

1910 WASHINGTON VALLEY RD
MARTINSVILLE NJ
08836-2026
US

V. Phone/Fax

Practice location:
  • Phone: 732-560-1990
  • Fax: 732-356-6333
Mailing address:
  • Phone: 732-560-1990
  • Fax: 732-356-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01757
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: