MEDICARE: JEFFREY WAYNE DANIELSON 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	3374	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45B78DA	OTHER	MN	BCBS ID NUMBER

General Provider Information

NPI Number	:	1821006453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WAYNE DANIELSON DC

Provider Business Mailing Address
First Line	:	13955 W PRESERVE BLVD # 200
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-7733
Country	:	US
Telephone Number	:	952-890-0804
Fax Number	:	952-890-1095

Provider Business Practice Location Address
First Line	:	13955 W PRESERVE BLVD # 200
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-7733
Country	:	US
Telephone Number	:	952-890-0804
Fax Number	:	952-890-1095

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	02/02/2012

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