Provider Demographics
NPI:1255414017
Name:LADEAIROUS, DANIEL THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:LADEAIROUS
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 1:5684 E CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-6142
Mailing Address - Country:US
Mailing Address - Phone:559-255-1268
Mailing Address - Fax:
Practice Address - Street 1:200 W SHAW AVE
Practice Address - Street 2:#114
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3684
Practice Address - Country:US
Practice Address - Phone:559-273-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor