Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | X002857 | NY |
NPI | 1265506562 |
---|---|
Provider Name | Dr. Daniel Joseph Mack SR. |
First Address | Webster, NY 14580-2350 |
Second Address | Webster, NY 14580-2350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26175 | (02) | NY |