Healthcare Provider Details

I. General information

NPI: 1962486779
Provider Name (Legal Business Name): JESSE MICHAEL TERNUS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 RIVERDALE DR NW SUITE D
RAMSEY MN
55303-7215
US

IV. Provider business mailing address

7850 RIVERDALE DR NW SUITE D
RAMSEY MN
55303-7215
US

V. Phone/Fax

Practice location:
  • Phone: 763-712-5986
  • Fax: 763-712-3916
Mailing address:
  • Phone: 763-712-5986
  • Fax: 763-712-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3863
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: