Provider Demographics
NPI:1053744805
Name:CORREA, DANIELLA RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:RENEE
Last Name:CORREA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:80 DESCANSO DR UNIT 1328
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1832
Mailing Address - Country:US
Mailing Address - Phone:408-637-8993
Mailing Address - Fax:
Practice Address - Street 1:2858 STEVENS CREEK BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4607
Practice Address - Country:US
Practice Address - Phone:408-637-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor