Healthcare Provider Details

I. General information

NPI: 1730808924
Provider Name (Legal Business Name): JULES EFTA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 S COLUMBIA RD
GRAND FORKS ND
58201-2830
US

IV. Provider business mailing address

4303 S COLUMBIA RD
GRAND FORKS ND
58201-2830
US

V. Phone/Fax

Practice location:
  • Phone: 218-201-1627
  • Fax:
Mailing address:
  • Phone: 218-201-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6988
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: