Provider Demographics
NPI:1538224340
Name:BASILICATO, DANIEL F (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:BASILICATO
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 1:192 WILLIAM RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2226
Mailing Address - Country:US
Mailing Address - Phone:973-919-2155
Mailing Address - Fax:
Practice Address - Street 1:192 WILLIAM RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2226
Practice Address - Country:US
Practice Address - Phone:973-919-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor