Provider Demographics
NPI:1881188449
Name:JAEGER, JOSHUA RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RICHARD
Last Name:JAEGER
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 1:4719 BANNING AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3217
Mailing Address - Country:US
Mailing Address - Phone:651-429-2279
Mailing Address - Fax:651-429-4361
Practice Address - Street 1:4719 BANNING AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3217
Practice Address - Country:US
Practice Address - Phone:651-429-2279
Practice Address - Fax:651-429-4361
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457693400Medicaid