MEDICARE: DR. GREGORY ROBERT DANIELS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0013X	Independent Medical Examiner Chiropractor	1931	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1931	OTHER	WI	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932326691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ROBERT DANIELS D.C.

Provider Business Mailing Address
First Line	:	2257 S 108TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-1107
Country	:	US
Telephone Number	:	141-432-7711
Fax Number	:	141-432-7671

Provider Business Practice Location Address
First Line	:	2257 S 108TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-1107
Country	:	US
Telephone Number	:	141-432-7711
Fax Number	:	141-432-7671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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