Healthcare Provider Details

I. General information

NPI: 1730252081
Provider Name (Legal Business Name): DR. JASON WING LOUIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 MIDDLE ST
LITTLE CANADA MN
55117-1411
US

IV. Provider business mailing address

2860 MIDDLE ST
LITTLE CANADA MN
55117-1411
US

V. Phone/Fax

Practice location:
  • Phone: 651-484-8783
  • Fax:
Mailing address:
  • Phone: 651-484-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4425
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: