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NPI Code Detail

MEDICARE: DR. JODI ELLEN BAKKEGARD D.C.

MEDICARE:  DR. JODI ELLEN BAKKEGARD  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
1111N00000XChiropractor3608MN

General Provider Information

NPI Number : 1528104619
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JODI ELLEN BAKKEGARD D.C.
Provider Business Mailing Address
First Line : 3304 W 44TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55410-1437
Country : US
Telephone Number : 612-929-2168
Fax Number :
Provider Business Practice Location Address
First Line : 3304 W 44TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55410-1437
Country : US
Telephone Number : 612-929-2168
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 07/08/2007

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Directions to “ DR. JODI ELLEN BAKKEGARD D.C.” Practice Location

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