Provider Demographics
NPI:1831122597
Name:PLOESSL, JESSE C (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:C
Last Name:PLOESSL
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 1:2125 UPPER 55TH ST E
Mailing Address - Street 2:STE 250
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-1719
Mailing Address - Country:US
Mailing Address - Phone:651-451-3311
Mailing Address - Fax:651-451-3377
Practice Address - Street 1:2125 UPPER 55TH ST E
Practice Address - Street 2:STE 250
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1719
Practice Address - Country:US
Practice Address - Phone:651-451-3311
Practice Address - Fax:651-451-3377
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN450613800Medicaid
MN294M8PLMedicare UPIN
MN350003060Medicare ID - Type Unspecified