Provider Demographics
NPI:1356405971
Name:KNUDSON, DANIEL BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRUCE
Last Name:KNUDSON
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 1:3 ROYALSTON
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5143
Mailing Address - Country:US
Mailing Address - Phone:949-463-1797
Mailing Address - Fax:
Practice Address - Street 1:600 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2106
Practice Address - Country:US
Practice Address - Phone:949-463-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor