Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 2922 | MN |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 54681 | MN |
NPI | 1275581795 |
---|---|
Provider Name | Dr. Jason Lavern Eggers |
First Address | Eagan, MN 55121-1002 |
Second Address | Eagan, MN 55121-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 06/05/2020 |