Healthcare Provider Details

I. General information

NPI: 1831122597
Provider Name (Legal Business Name): JESSE C. PLOESSL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 UPPER 55TH ST E STE 250
INVER GROVE HEIGHTS MN
55077-1719
US

IV. Provider business mailing address

2125 UPPER 55TH ST E STE 250
INVER GROVE HEIGHTS MN
55077-1719
US

V. Phone/Fax

Practice location:
  • Phone: 651-451-3311
  • Fax: 651-451-3377
Mailing address:
  • Phone: 651-451-3311
  • Fax: 651-451-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4505
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: