MEDICARE: J & J CHIROPRACTIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4601	MN

General Provider Information

NPI Number	:	1356523849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J & J CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	8058 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8058 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:	763-425-1855
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH SEONG LEE
Credential	:	D.C.
Telephone Number	:	763-425-1855

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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