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General NPI Number Information
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NPI Number | 1053615559
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Entity Type | Organization
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Legal Business Name | JLA CORPORATION
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 5009 EXCELSIOR BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-3041
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Country | US
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Telephone | 612-799-7982
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Fax |
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Provider Business Mailing Address
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Address Line | 2535 PARK AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4404
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Country | US
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Telephone | 612-799-7982
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN LEE ARNOLD
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Credential | D.C.
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Telephone | 612-799-7982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 855
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5074
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License Number State | MN
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