Provider Demographics
NPI:1366435091
Name:ZIESKE, DONALD MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:ZIESKE
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:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MN
Mailing Address - Zip Code:56273-0241
Mailing Address - Country:US
Mailing Address - Phone:320-354-4793
Mailing Address - Fax:320-354-4585
Practice Address - Street 1:17 ASH ST NE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-9567
Practice Address - Country:US
Practice Address - Phone:320-354-4793
Practice Address - Fax:320-354-4793
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45999ZIOtherBLUE CROSS BLUE SHIELD
MN44-40376OtherMEDICA
MN44-40376OtherMEDICA