Provider Demographics
NPI:1992170591
Name:LEDUC, DANIEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:LEDUC
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 1:1005 CROSSING DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-4626
Mailing Address - Country:US
Mailing Address - Phone:218-686-0384
Mailing Address - Fax:
Practice Address - Street 1:1005 CROSSING DR STE 120
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-4626
Practice Address - Country:US
Practice Address - Phone:218-686-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor