Provider Demographics
NPI:1760695316
Name:JILLIAN-OHANA, CAROL ELAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ELAINE
Last Name:JILLIAN-OHANA
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 1:193 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014
Mailing Address - Country:US
Mailing Address - Phone:612-871-5622
Mailing Address - Fax:
Practice Address - Street 1:7094 LAKE DRIVE
Practice Address - Street 2:CIRCLE OF HEALING ARTS
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014
Practice Address - Country:US
Practice Address - Phone:612-871-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350002688Medicare ID - Type Unspecified