Provider Demographics
NPI:1851747505
Name:LUTZ, WILLIAM B (DC, ATC, MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DC, ATC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PARK AVE UNIT 308
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1167
Mailing Address - Country:US
Mailing Address - Phone:651-983-1860
Mailing Address - Fax:
Practice Address - Street 1:2145 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1900
Practice Address - Country:US
Practice Address - Phone:651-698-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO010509111N00000X
GAAT0029222255A2300X
MN7240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer