Provider Demographics
NPI:1619085784
Name:DEAL, JOSEPH BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRIAN
Last Name:DEAL
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:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-1300
Mailing Address - Country:US
Mailing Address - Phone:507-726-2091
Mailing Address - Fax:
Practice Address - Street 1:201 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055-1300
Practice Address - Country:US
Practice Address - Phone:507-726-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500228100Medicaid
MN3C200DEOtherBLUE CROSS BLUE SHIELD