Provider Demographics
NPI:1942381454
Name:DUININCK, DAVID LEE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:DUININCK
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 1:1550 WILLMAR AVE SE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2754
Mailing Address - Country:US
Mailing Address - Phone:320-235-5913
Mailing Address - Fax:
Practice Address - Street 1:1550 WILLMAR AVE SE, SUITE B
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201
Practice Address - Country:US
Practice Address - Phone:320-235-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN629327OtherACN - CHIROCARE
MN68094DUOtherBCBS MN
MNT70701Medicare UPIN