Basic Information
| Provider Information | |||||||||
| NPI: | 1578005674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1813 SIGNATURE CIR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805042640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202034080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RICHFIELD | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847012061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358934100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2016 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | UT | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.