Provider Demographics
NPI:1811234628
Name:CATHCART, JEROD CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROD
Middle Name:CRAIG
Last Name:CATHCART
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 1:441 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2085
Mailing Address - Country:US
Mailing Address - Phone:165-120-7479
Mailing Address - Fax:651-207-4028
Practice Address - Street 1:441 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2085
Practice Address - Country:US
Practice Address - Phone:165-120-7479
Practice Address - Fax:651-207-4028
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor