Healthcare Provider Details

I. General information

NPI: 1255333845
Provider Name (Legal Business Name): DANIEL SIMEON LUTZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CIVIC HEIGHTS DR STE 108
CIRCLE PINES MN
55014-4711
US

IV. Provider business mailing address

620 CIVIC HEIGHTS DR STE 108
CIRCLE PINES MN
55014-4711
US

V. Phone/Fax

Practice location:
  • Phone: 763-795-8300
  • Fax: 763-795-8302
Mailing address:
  • Phone: 763-795-8300
  • Fax: 763-795-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003573
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: