Healthcare Provider Details

I. General information

NPI: 1013149442
Provider Name (Legal Business Name): JASON PAUL STRANDBERG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PLYMOUTH RD APT 417
MINNETONKA MN
55305-1986
US

IV. Provider business mailing address

14604 WOODHAVEN RD
MINNETONKA MN
55345-2362
US

V. Phone/Fax

Practice location:
  • Phone: 612-306-5691
  • Fax: 612-235-7918
Mailing address:
  • Phone: 952-222-7886
  • Fax: 612-235-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC3969
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC3969
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC3969
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC3969
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: