Provider Demographics
NPI:1710072533
Name:MCDONALD, KARI JO (DC)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:JO
Last Name:MCDONALD
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 1:20591 JUPITER CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5984
Mailing Address - Country:US
Mailing Address - Phone:952-469-5178
Mailing Address - Fax:
Practice Address - Street 1:2424 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1269
Practice Address - Country:US
Practice Address - Phone:952-894-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU18567Medicare UPIN