Provider Demographics
NPI:1417023706
Name:KLEIN, JEFFREY KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENNETH
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 CEDAR ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-4663
Mailing Address - Country:US
Mailing Address - Phone:763-421-2710
Mailing Address - Fax:763-421-0687
Practice Address - Street 1:11468 MARKETPLACE DR N
Practice Address - Street 2:SUITE 500
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3872
Practice Address - Country:US
Practice Address - Phone:763-421-2710
Practice Address - Fax:763-421-0687
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN275415100OtherMHCP PROVIDER NUMBER
MN275415100OtherMHCP PROVIDER NUMBER