MEDICARE: JON RONALD JIROVEC MA, LADC

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	390200000X	Student in an Organized Health Care Education/Training Program		MN

General Provider Information

NPI Number	:	1508731126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON RONALD JIROVEC MA, LADC

Provider Business Mailing Address
First Line	:	7565 N SHORE CIR N
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8711
Country	:	US
Telephone Number	:	612-655-3790
Fax Number	:	612-655-3790

Provider Business Practice Location Address
First Line	:	7565 N SHORE CIR N
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8711
Country	:	US
Telephone Number	:	612-655-3790
Fax Number	:	612-655-3790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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