Provider Demographics
NPI:1952410045
Name:LANTZ, NICOLE KRISTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KRISTIN
Last Name:LANTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3440 FEDERAL DR
Mailing Address - Street 2:STE 120
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3516
Mailing Address - Country:US
Mailing Address - Phone:612-781-9801
Mailing Address - Fax:952-895-9408
Practice Address - Street 1:12280 NICOLLET AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1649
Practice Address - Country:US
Practice Address - Phone:952-895-0660
Practice Address - Fax:952-895-9408
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN265400800Medicaid
MN265400800Medicaid