Provider Demographics
NPI:1649219262
Name:JO, CHRISTOPHER DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DOUGLAS
Last Name:JO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:3948 W 50TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1253
Mailing Address - Country:US
Mailing Address - Phone:612-920-0720
Mailing Address - Fax:952-927-4226
Practice Address - Street 1:3948 W 50TH ST
Practice Address - Street 2:STE 203
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1210
Practice Address - Country:US
Practice Address - Phone:952-920-4528
Practice Address - Fax:952-927-4226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2018-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN3936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN887953200Medicaid