Provider Demographics
NPI:1821326497
Name:DEAN, CHRISTOPHER DARYL (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DARYL
Last Name:DEAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 ANNAPOLIS LN N
Mailing Address - Street 2:APT 2221
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-1146
Mailing Address - Country:US
Mailing Address - Phone:952-913-1637
Mailing Address - Fax:
Practice Address - Street 1:9112 EDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8514
Practice Address - Country:US
Practice Address - Phone:763-228-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor