Provider Demographics
NPI:1790094944
Name:PROKES, JOANNA E (DC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:E
Last Name:PROKES
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 1:2800 SELKIRK DR
Mailing Address - Street 2:APT. C311
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5671
Mailing Address - Country:US
Mailing Address - Phone:952-484-0110
Mailing Address - Fax:
Practice Address - Street 1:2800 SELKIRK DR
Practice Address - Street 2:APT. C311
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5671
Practice Address - Country:US
Practice Address - Phone:952-484-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor