Active NPI
Daniel Lee Doerschuk, PRESIDENT
- Home Modifications Contractor
- Canton, OH
National Provider Identifier
1407442593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 5255
- Practice address
- 2720 Atlantic Blvd NE
Canton, OH 44705-3923 - Phone
- (330) 455-1868
- Fax
- (330) 455-2020
- NPI assigned
- Dec 14, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 5255 | OH | Primary |
Addresses
Primary practice location
2720 Atlantic Blvd NE
Canton, OH 44705-3923
Mailing address
2720 Atlantic Blvd NE
Canton, OH 44705-3923
Phone (330) 455-1868
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5255 | OH | MD | Adult Development & Aging Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607904000000",
"number": "1407442593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2720 ATLANTIC BLVD NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447053923",
"telephone_number": "330-455-1868",
"fax_number": "330-455-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 ATLANTIC BLVD NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447053923",
"telephone_number": "330-455-1868",
"fax_number": "330-455-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOERSCHUK",
"first_name": "DANIEL",
"middle_name": "LEE",
"credential": "PRESIDENT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-14",
"last_updated": "2020-12-14",
"certification_date": "2020-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "OH",
"license": "5255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.