Provider Demographics
NPI:1811993173
Name:GRANROTH, DANIELLE BUSKE (DC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BUSKE
Last Name:GRANROTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:BUSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2321 TROOP DR
Mailing Address - Street 2:APT 211
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4556
Mailing Address - Country:US
Mailing Address - Phone:320-230-5694
Mailing Address - Fax:
Practice Address - Street 1:58 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3047
Practice Address - Country:US
Practice Address - Phone:320-632-6704
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU89597Medicare UPIN