Healthcare Provider Details

I. General information

NPI: 1205388691
Provider Name (Legal Business Name): MR. CHRISTOPHER DAVID DENZLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W SUPERIOR ST SUITE 300
DULUTH MN
55802-1808
US

IV. Provider business mailing address

1900 SILVER LAKE ROAD NW SUITE 110
NEW BRIGHTON MN
55112
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-4379
  • Fax: 218-722-4333
Mailing address:
  • Phone: 651-379-1764
  • Fax: 651-379-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: