Provider Demographics
NPI:1568592764
Name:BRINK, DANIELLE KALLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:KALLIN
Last Name:BRINK
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 1:11185 LAKE BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9826
Mailing Address - Country:US
Mailing Address - Phone:651-257-3914
Mailing Address - Fax:
Practice Address - Street 1:11185 LAKE BLVD
Practice Address - Street 2:STE 208
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9826
Practice Address - Country:US
Practice Address - Phone:651-257-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN125320400Medicaid
MN147R0BROtherBLUE CROSS BLUE SHIELD
MN125320400Medicaid
MN350002582Medicare ID - Type Unspecified