Healthcare Provider Details

I. General information

NPI: 1457311391
Provider Name (Legal Business Name): DANIEL JAMES HAFNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 GRAND AVE
SAINT PAUL MN
55105-2227
US

IV. Provider business mailing address

1843 OLDRIDGE AVE N
STILLWATER MN
55082-2823
US

V. Phone/Fax

Practice location:
  • Phone: 651-690-9366
  • Fax:
Mailing address:
  • Phone: 651-690-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3380
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: