Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5485 | MN |
NPI | 1265738421 |
---|---|
Provider Name | Dr. Don Lee Jewell |
First Address | Maple Grove, MN 55369-4510 |
Second Address | Maple Grove, MN 55369-4510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 21/09/2012 |