Provider Demographics
NPI:1447375506
Name:DANIEL, MARK LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6315 SPALDING DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:770-416-9995
Mailing Address - Fax:770-416-6777
Practice Address - Street 1:6315 SPALDING DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:770-416-9995
Practice Address - Fax:770-416-6777
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95001Medicare UPIN
35ZCHXBMedicare ID - Type Unspecified