=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255571493
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL E LARA D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2009
-----------------------------------------------------
Last Update Date | 07/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 CLAIREDAN DR
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43065-8064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-505-8600
-----------------------------------------------------
Fax | 614-505-6025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 STRINGTOWN RD
-----------------------------------------------------
City | GROVE CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43123-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-871-2273
-----------------------------------------------------
Fax | 614-871-3324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3966
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------