Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4676 | MN |
NPI | 1003977265 |
---|---|
Provider Name | Dr. Jeffrey John Sailer |
First Address | Sartell, MN 56377-2504 |
Second Address | Sartell, MN 56377-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 09/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V05749 | (02) | MN |