Healthcare Provider Details

I. General information

NPI: 1649329749
Provider Name (Legal Business Name): LUKE MATTHEW JAKUBOWSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SILVER BELL RD SUITE #2
EAGAN MN
55122-1050
US

IV. Provider business mailing address

11689 MILLPOND AVE
BURNSVILLE MN
55337-7251
US

V. Phone/Fax

Practice location:
  • Phone: 651-233-3738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4802
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: