Healthcare Provider Details

I. General information

NPI: 1033257621
Provider Name (Legal Business Name): DANIEL PAUL KIRK LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 SAVAGE RD SUITE 400 C
CHARLESTON SC
29407-4704
US

IV. Provider business mailing address

4408 GAYNELLE DR
CHARLOTTE NC
28215-5712
US

V. Phone/Fax

Practice location:
  • Phone: 866-571-2700
  • Fax: 843-571-2124
Mailing address:
  • Phone: 704-567-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number867
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: