Provider Demographics
NPI:1609328251
Name:KLEMEK, JILLIAN (DC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:KLEMEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W SOO ST
Mailing Address - Street 2:
Mailing Address - City:PARKERS PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56361-4400
Mailing Address - Country:US
Mailing Address - Phone:218-338-2492
Mailing Address - Fax:
Practice Address - Street 1:115 W SOO ST
Practice Address - Street 2:
Practice Address - City:PARKERS PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56361-4400
Practice Address - Country:US
Practice Address - Phone:218-338-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor