MEDICARE: DR. DANIEL SIMEON LUTZ DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	003573	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00B20LU	OTHER	MN	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1501695	OTHER	MN	FIRST HEALTH

General Provider Information

NPI Number	:	1255333845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL SIMEON LUTZ DC

Provider Business Mailing Address
First Line	:	620 CIVIC HEIGHTS DR
Second Line	:	STE 108
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-4711
Country	:	US
Telephone Number	:	763-795-8300
Fax Number	:	763-795-8302

Provider Business Practice Location Address
First Line	:	620 CIVIC HEIGHTS DR
Second Line	:	STE 108
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-4711
Country	:	US
Telephone Number	:	763-795-8300
Fax Number	:	763-795-8302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	11/15/2017

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