Provider Demographics
NPI:1871901132
Name:DANIELLS, EDMOND MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:MICHAEL
Last Name:DANIELLS
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 1:213 NEW HAVEN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4830
Mailing Address - Country:US
Mailing Address - Phone:203-787-8384
Mailing Address - Fax:
Practice Address - Street 1:213 NEW HAVEN AVE FL 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4830
Practice Address - Country:US
Practice Address - Phone:203-783-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor