Provider Demographics
NPI:1821672783
Name:MINER, DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:16731 HIGHWAY 13 S STE 107A
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2975
Mailing Address - Country:US
Mailing Address - Phone:320-582-0582
Mailing Address - Fax:
Practice Address - Street 1:16731 HIGHWAY 13 S STE 107A
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2975
Practice Address - Country:US
Practice Address - Phone:320-582-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor