Provider Demographics
NPI:1235283995
Name:JARVIS, DANIEL MARK (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3629
Mailing Address - Country:US
Mailing Address - Phone:406-540-4404
Mailing Address - Fax:406-493-1001
Practice Address - Street 1:1505 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3629
Practice Address - Country:US
Practice Address - Phone:406-540-4404
Practice Address - Fax:406-493-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011005450Medicare UPIN