Provider Demographics
NPI:1285039099
Name:OTT, DANIELLE R (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:R
Last Name:OTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PEMBROKE AVE S
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1242
Mailing Address - Country:US
Mailing Address - Phone:651-560-4070
Mailing Address - Fax:
Practice Address - Street 1:165 PEMBROKE S AVE
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1242
Practice Address - Country:US
Practice Address - Phone:651-560-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor