1548712219 NPI number — MS. SHELBY ELISHA JOHNSRUD D.C.

Table of content: MS. SHELBY ELISHA JOHNSRUD D.C. (NPI 1548712219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548712219 NPI number — MS. SHELBY ELISHA JOHNSRUD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSRUD
Provider First Name:
SHELBY
Provider Middle Name:
ELISHA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1548712219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 WEST 22ND AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-846-9600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 WEST 22ND AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-846-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2016

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:  6278 , 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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