Provider Demographics
NPI:1699832600
Name:LOTZER, JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LOTZER
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 1:213 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2740
Mailing Address - Country:US
Mailing Address - Phone:218-233-5141
Mailing Address - Fax:218-233-3348
Practice Address - Street 1:213 7TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2740
Practice Address - Country:US
Practice Address - Phone:218-233-5141
Practice Address - Fax:218-233-3348
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350022213OtherRAILROAD MEDICARE
MN359000660Medicare ID - Type Unspecified