Individual provider Active NPI

David Joseph Lutz, DC

  • Chiropractor
  • Brooklyn Center, MN
National Provider Identifier
1013944966
Registry record updated Sep 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3057 Issued in MN
Practice address
5740 Brooklyn Boulevard
100
Brooklyn Center, MN 55429
Phone
(763) 561-4045
Fax
(763) 561-8690
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3057 MN Primary

Addresses

Primary practice location

5740 Brooklyn Boulevard
100
Brooklyn Center, MN 55429

Mailing address

5740 Brooklyn Boulevard
100
Brooklyn Center, MN 55429
Phone (763) 561-4045

Other identifiers 1

IdentifierTypeStateIssuer
044727700MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050113000205 MN Practitioner - Chiropractic 9032168414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kent J. Erickson, D.C., CHTDGroup PAC ID 6507839586, 4 clinicians

Practice addresses (Care Compare)

5740 Brooklyn Blvd
Suite 100
Brooklyn Center, MN 55429-3093
Phone (763) 561-4045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3057MNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Kent J. Erickson, D.C., CHTD Chiropractor CurrentSince Nov 1, 2006 Accepting new patients

Locations

5740 Brooklyn Blvd
Ste 100
Minneapolis, MN 55429
Phone (612) 561-4045

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315958400000",
    "number": "1013944966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5740 BROOKLYN BOULEVARD",
            "address_2": "100",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "55429",
            "telephone_number": "763-561-4045",
            "fax_number": "763-561-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5740 BROOKLYN BOULEVARD",
            "address_2": "100",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "55429",
            "telephone_number": "763-561-4045",
            "fax_number": "763-561-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTZ",
        "first_name": "DAVID",
        "middle_name": "JOSEPH",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2011-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044727700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.