Healthcare Provider Details

I. General information

NPI: 1306023353
Provider Name (Legal Business Name): JONATHAN MICHAEL PLOEGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 NICOLLET AVE SUITE 323
BURNSVILLE MN
55337-5901
US

IV. Provider business mailing address

280 12TH ST SW SUITE B
FOREST LAKE MN
55025-3778
US

V. Phone/Fax

Practice location:
  • Phone: 612-760-6621
  • Fax:
Mailing address:
  • Phone: 612-760-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5069
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: