Provider Demographics
NPI:1346285418
Name:NEUBAUER, SEAN DANIEL
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:DANIEL
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 W 78TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4525
Mailing Address - Country:US
Mailing Address - Phone:952-934-1772
Mailing Address - Fax:952-934-3114
Practice Address - Street 1:470 W 78TH ST STE 100
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4525
Practice Address - Country:US
Practice Address - Phone:952-934-1772
Practice Address - Fax:952-934-3114
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC4015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN70B64NEOtherBCBS OF MINNESOTA
MN5991285-00Medicaid
350002749Medicare ID - Type Unspecified
MN5991285-00Medicaid