MEDICARE: DOCKTER - LUTZ CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3400	MN
2	111N00000X	Chiropractor	3433	MN
3	111N00000X	Chiropractor	3573	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255333845	OTHER	MN	DANIEL S LUTZ NPI
2	1932216249	OTHER	MN	VAUGHN N REENTS NPI
3	1205838869	OTHER	MN	CHRISTOPHER A DOCKTER NPI

General Provider Information

NPI Number	:	1093816258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCKTER - LUTZ CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	620 CIVIC HEIGHTS DR
Second Line	:	SUITE 108
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-4711
Country	:	US
Telephone Number	:	763-795-8300
Fax Number	:	763-795-8302

Provider Business Practice Location Address
First Line	:	620 CIVIC HEIGHTS DR
Second Line	:	SUITE 108
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-4711
Country	:	US
Telephone Number	:	763-795-8300
Fax Number	:	763-795-8302

Authorized Official
Title or Position	:	DIRECTOR OF HUMAN RESOURCES
Name	:	MARIA L SKOTTERUD
Credential	:
Telephone Number	:	763-795-8300

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/07/2007

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Directions to “DOCKTER - LUTZ CHIROPRACTIC, LLC ” Practice Location

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