Provider Demographics
NPI:1972799377
Name:JUETTEN, HERBERT JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:JOSEPH
Last Name:JUETTEN
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 1:232 MAIN ST N
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-1517
Mailing Address - Country:US
Mailing Address - Phone:320-468-2221
Mailing Address - Fax:
Practice Address - Street 1:232 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1517
Practice Address - Country:US
Practice Address - Phone:320-468-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350027767OtherRAILROAD MEDICARE
MN350027767OtherRAILROAD MEDICARE