MEDICARE: DR. DONALD MICHAEL ZIESKE D.C.

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	1477	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45999ZI	OTHER	MN	BLUE CROSS BLUE SHIELD
2	44-40376	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1366435091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD MICHAEL ZIESKE D.C.

Provider Business Mailing Address
First Line	:	PO BOX 241
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-0241
Country	:	US
Telephone Number	:	320-354-4793
Fax Number	:	320-354-4585

Provider Business Practice Location Address
First Line	:	17 ASH ST NE
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9567
Country	:	US
Telephone Number	:	320-354-4793
Fax Number	:	320-354-4793

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	07/08/2007

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