Provider Demographics
NPI:1033448634
Name:LILLEJORD, JESSE RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:RAY
Last Name:LILLEJORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:RAY
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:800 PRAIRIE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7328
Mailing Address - Country:US
Mailing Address - Phone:952-943-1188
Mailing Address - Fax:952-943-1177
Practice Address - Street 1:800 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7328
Practice Address - Country:US
Practice Address - Phone:952-943-1188
Practice Address - Fax:952-943-1177
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor