Healthcare Provider Details

I. General information

NPI: 1881885879
Provider Name (Legal Business Name): JEREMY THOMAS HURKMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 SLOAN PL STE 250
SAINT PAUL MN
55117-2181
US

IV. Provider business mailing address

1973 SLOAN PL STE 250
SAINT PAUL MN
55117-2181
US

V. Phone/Fax

Practice location:
  • Phone: 651-771-2012
  • Fax: 651-771-8747
Mailing address:
  • Phone: 651-771-2012
  • Fax: 651-771-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4398-012
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4997
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: