Active NPI
Daniel R. Prideaux, D.C.
- Sports Physician Chiropractor
- Missoula, MT
National Provider Identifier
1851496467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 437
- Practice address
- 1001 SW Higgins Ave
Suite 102
Missoula, MT 59803-1341 - Phone
- (406) 721-4425
- Fax
- (406) 721-4426
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 437 | MT | Primary |
Addresses
Primary practice location
1001 SW Higgins Ave
Suite 102
Missoula, MT 59803-1341
Mailing address
1001 SW Higgins Ave
Suite 102
Missoula, MT 59803-1341
Phone (406) 721-4425
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4142-0 | Other | MT | BC/BS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 437 | MT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851496467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 SW HIGGINS AVE",
"address_2": "SUITE 102",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598031341",
"telephone_number": "406-721-4425",
"fax_number": "406-721-4426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 SW HIGGINS AVE",
"address_2": "SUITE 102",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598031341",
"telephone_number": "406-721-4425",
"fax_number": "406-721-4426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIDEAUX",
"first_name": "DANIEL",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "MT",
"license": "437",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "4142-0",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.