=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740791219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEDUC CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2017
-----------------------------------------------------
Last Update Date | 10/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 CROSSING DR STE 120
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55328-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1005 CROSSING DR STE 120
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55328-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | DR. DANIEL JOHN LEDUC
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 218-686-0384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6147
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------