Healthcare Provider Details

I. General information

NPI: 1275581795
Provider Name (Legal Business Name): JASON LAVERN EGGERS MD, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 VIKINGS CIR
EAGAN MN
55121-1002
US

IV. Provider business mailing address

2700 VIKINGS CIR
EAGAN MN
55121-1002
US

V. Phone/Fax

Practice location:
  • Phone: 952-456-7600
  • Fax: 952-456-7601
Mailing address:
  • Phone: 952-456-7600
  • Fax: 952-456-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2922
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number54681
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number54681
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: