Provider Demographics
NPI:1760712657
Name:JOVANOVIC, CHRISTIAN INVICTUS (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:INVICTUS
Last Name:JOVANOVIC
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:MR
Other - First Name:CHRISTIAN
Other - Middle Name:MATTHEW
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2501 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1602
Mailing Address - Country:US
Mailing Address - Phone:952-888-4777
Mailing Address - Fax:952-886-7561
Practice Address - Street 1:2501 W 84TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1602
Practice Address - Country:US
Practice Address - Phone:952-888-4777
Practice Address - Fax:952-886-7561
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist