Provider Demographics
NPI:1336515550
Name:DOC DJR PC
Entity Type:Organization
Organization Name:DOC DJR PC
Other - Org Name:COMMUNITY ACCIDENT & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-566-8023
Mailing Address - Street 1:13060 CENTRAL AVE NE
Mailing Address - Street 2:#100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4149
Mailing Address - Country:US
Mailing Address - Phone:763-566-8023
Mailing Address - Fax:763-566-0630
Practice Address - Street 1:13060 CENTRAL AVE NE
Practice Address - Street 2:#100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4149
Practice Address - Country:US
Practice Address - Phone:763-566-8023
Practice Address - Fax:763-566-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty