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General NPI Number Information
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NPI Number | 1851747505
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Entity Type | Individual
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Provider Name | WILLIAM B LUTZ DC, ATC, MS
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Gender | Male
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 2145 FORD PKWY
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City | SAINT PAUL
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State | MN
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Zip | 55116-1900
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Country | US
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Telephone | 651-698-6803
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Fax |
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Provider Business Mailing Address
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Address Line | 250 PARK AVE UNIT 308
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1167
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Country | US
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Telephone | 651-983-1860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO010509
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002922
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7240
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License Number State | MN
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