Provider Demographics
NPI:1154546901
Name:RICHTER, DANIEL JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:RICHTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13060 CENTRAL AVE NE
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4149
Mailing Address - Country:US
Mailing Address - Phone:763-566-8023
Mailing Address - Fax:763-566-0630
Practice Address - Street 1:13060 CENTRAL AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4149
Practice Address - Country:US
Practice Address - Phone:763-566-8023
Practice Address - Fax:763-566-0630
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV05747Medicare UPIN
MN35000425Medicare PIN