Healthcare Provider Details

I. General information

NPI: 1184996365
Provider Name (Legal Business Name): JEFFREY WILL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 E RIVER RD STE 4
ANOKA MN
55303-1891
US

IV. Provider business mailing address

9125 QUADAY AVE NE STE 102
OTSEGO MN
55330-6662
US

V. Phone/Fax

Practice location:
  • Phone: 763-421-1410
  • Fax:
Mailing address:
  • Phone: 763-274-0373
  • Fax: 763-274-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6353
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: