Provider Demographics
NPI:1487401212
Name:PIETRUSZEWSKI, DANIEL MATHEW
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MATHEW
Last Name:PIETRUSZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:MATHEW
Other - Last Name:PIETRUSZEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:7781 AMANA TRL # 300
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-2617
Mailing Address - Country:US
Mailing Address - Phone:651-237-3799
Mailing Address - Fax:
Practice Address - Street 1:7781 AMANA TRL
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-2617
Practice Address - Country:US
Practice Address - Phone:651-280-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor