Provider Demographics
NPI:1730125782
Name:JURGENSON, RANDY J (DC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:J
Last Name:JURGENSON
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 1:1507 JEFFERSON ST SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350
Mailing Address - Country:US
Mailing Address - Phone:320-587-2215
Mailing Address - Fax:320-587-4963
Practice Address - Street 1:1507 JEFFERSON ST SE
Practice Address - Street 2:SUITE 1
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350
Practice Address - Country:US
Practice Address - Phone:320-587-2215
Practice Address - Fax:320-587-4963
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54F02JUOtherBLUE CROSS BLUE SHIELD
MN416492435OtherMEDICA
MN03071156OtherPRIMEWEST
MN344727800Medicaid
MN0303OtherPREFERRED ONE
MN603860OtherACN CHIROCARE
MN416492435OtherMEDICA
MN350002553Medicare ID - Type Unspecified