Provider Demographics
NPI:1518367440
Name:O'CONNELL, DANIELLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MARIE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:GERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1752 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-428-0639
Mailing Address - Fax:
Practice Address - Street 1:KNEWTSON HEALTH GROUP
Practice Address - Street 2:23505 SMITHTOWN RD SUITE 100
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331
Practice Address - Country:US
Practice Address - Phone:952-470-8555
Practice Address - Fax:952-401-8758
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400177527Medicare PIN