Provider Demographics
NPI:1538265202
Name:MICHALEC, DANIEL ANDREW (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:MICHALEC
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 1:5261 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630
Mailing Address - Country:US
Mailing Address - Phone:773-283-0354
Mailing Address - Fax:773-283-0457
Practice Address - Street 1:5261 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-283-0354
Practice Address - Fax:773-283-0457
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL168214BOtherBLUE CROSS BLUE SHIELD
IL168214BOtherBLUE CROSS BLUE SHIELD
444740Medicare ID - Type Unspecified