MEDICARE: DR. JAY ALLEN EBEL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	538	ND
2	111N00000X	Chiropractor	3038	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3C096CB	OTHER	MN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3C095HA	OTHER	MN	BCBS
4	11445	OTHER	ND	BCBS

General Provider Information

NPI Number	:	1194722207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY ALLEN EBEL D.C.

Provider Business Mailing Address
First Line	:	915 - 7TH STREET, #15
Second Line	:
City	:	JORDAN
State	:	MN
Zip	:	55352
Country	:	US
Telephone Number	:	952-378-1030
Fax Number	:	952-378-1030

Provider Business Practice Location Address
First Line	:	2330 SIOUX TRAIL N.W.
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372
Country	:	US
Telephone Number	:	952-233-4271
Fax Number	:	952-233-4224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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