Provider Demographics
NPI:1174681415
Name:PAIGE, DANIEL JESSE (MS, LAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JESSE
Last Name:PAIGE
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 MARIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2018
Mailing Address - Country:US
Mailing Address - Phone:510-292-8793
Mailing Address - Fax:
Practice Address - Street 1:1738 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2215
Practice Address - Country:US
Practice Address - Phone:510-292-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10922171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist