Provider Demographics
NPI:1053398503
Name:MCCOLLUM, DANIEL A (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:MCCOLLUM
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 1:115 BRUSHY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1120
Mailing Address - Country:US
Mailing Address - Phone:864-855-1655
Mailing Address - Fax:864-855-1323
Practice Address - Street 1:115 BRUSHY CREEK RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1120
Practice Address - Country:US
Practice Address - Phone:864-855-1655
Practice Address - Fax:864-855-1323
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1053398503OtherNPI
SCCH1792Medicaid
SC1792OtherSTATE LICENSE
SC1792OtherSTATE LICENSE
U346296089Medicare ID - Type Unspecified