Provider Demographics
NPI:1508939091
Name:OCHSENDORF, JEROD LYNN (DC, CCSP, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEROD
Middle Name:LYNN
Last Name:OCHSENDORF
Suffix:
Gender:M
Credentials:DC, CCSP, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1304
Mailing Address - Country:US
Mailing Address - Phone:320-762-2055
Mailing Address - Fax:
Practice Address - Street 1:114 5TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1304
Practice Address - Country:US
Practice Address - Phone:320-762-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260441800Medicaid
MN350004518OtherMEDICARE PTAN
MN77G43OCOtherBCBS 'AWARE' PROVIDER
MN260441800Medicaid