Provider Demographics
NPI:1194182162
Name:OPITZ, DANIEL MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MATTHEW
Last Name:OPITZ
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 1:200 E TRAVELERS TRL STE 115
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4108
Mailing Address - Country:US
Mailing Address - Phone:952-412-2514
Mailing Address - Fax:
Practice Address - Street 1:13809 JAMES AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4434
Practice Address - Country:US
Practice Address - Phone:952-412-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor