1306023353 NPI number — DR. JONATHAN MICHAEL PLOEGER D.C.

Table of content: DR. JONATHAN MICHAEL PLOEGER D.C. (NPI 1306023353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306023353 NPI number — DR. JONATHAN MICHAEL PLOEGER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOEGER
Provider First Name:
JONATHAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306023353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 12TH ST SW
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FOREST LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55025-3778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-760-6621
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12501 NICOLLET AVE
Provider Second Line Business Practice Location Address:
SUITE 323
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55337-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-760-6621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5069 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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