Healthcare Provider Details

I. General information

NPI: 1235219767
Provider Name (Legal Business Name): JEAN CIOLA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 COUNTY ROAD 101 SUITE 2
MINNETONKA MN
55391
US

IV. Provider business mailing address

3311 COUNTY RD 101 SUITE 2
MINNETONKA MN
55391-2866
US

V. Phone/Fax

Practice location:
  • Phone: 952-405-6263
  • Fax: 952-406-8060
Mailing address:
  • Phone: 952-405-6263
  • Fax: 952-406-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4542
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: