=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437581022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE KLICK D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2013
-----------------------------------------------------
Last Update Date | 01/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4444 W 76TH ST SUITE 300
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-5173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-481-4457
-----------------------------------------------------
Fax | 952-516-5175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8654 POPLAR BRIDGE CURV
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55437-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-481-4457
-----------------------------------------------------
Fax | 952-516-5175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5764
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------