Provider Demographics
NPI:1699835678
Name:WHEELER, JON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:LEE
Last Name:WHEELER
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 457
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-0457
Mailing Address - Country:US
Mailing Address - Phone:320-286-6478
Mailing Address - Fax:320-286-6507
Practice Address - Street 1:225 MILLARD AVENUE
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-0457
Practice Address - Country:US
Practice Address - Phone:320-286-6478
Practice Address - Fax:320-286-6507
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN474809300Medicaid
MN476R6WHOtherBLUE CROSS BLUE SHIELD