Healthcare Provider Details

I. General information

NPI: 1487538419
Provider Name (Legal Business Name): DANIEL AXELROD DC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HARBOR DR
LIDO BEACH NY
11561-4906
US

IV. Provider business mailing address

180 WAVERLY ST
SUNNYVALE CA
94086-6021
US

V. Phone/Fax

Practice location:
  • Phone: 516-233-9003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: