=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225595499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL EVAN VOEGELE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2019
-----------------------------------------------------
Last Update Date | 05/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6445 LAKE ROAD TER STE 302
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-1495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-294-2332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2090 VALLEY CREEK LN
-----------------------------------------------------
City | SHAKOPEE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55379-4617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-491-3497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6592
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------