Provider Demographics
NPI:1093816258
Name:DOCKTER - LUTZ CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DOCKTER - LUTZ CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKOTTERUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-795-8300
Mailing Address - Street 1:620 CIVIC HEIGHTS DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-4711
Mailing Address - Country:US
Mailing Address - Phone:763-795-8300
Mailing Address - Fax:763-795-8302
Practice Address - Street 1:620 CIVIC HEIGHTS DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-4711
Practice Address - Country:US
Practice Address - Phone:763-795-8300
Practice Address - Fax:763-795-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3400111N00000X
MN3433111N00000X
MN3573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1255333845OtherDANIEL S LUTZ NPI
MN1932216249OtherVAUGHN N REENTS NPI
MN1205838869OtherCHRISTOPHER A DOCKTER NPI
MNU69196Medicare UPIN
MN1255333845OtherDANIEL S LUTZ NPI
MN1205838869OtherCHRISTOPHER A DOCKTER NPI
MNU63550Medicare UPIN