Provider Demographics
NPI:1245344035
Name:DECKERT, MICHAEL JAY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:DECKERT
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 1:2020 SILVER BELL RD
Mailing Address - Street 2:STE 9
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1050
Mailing Address - Country:US
Mailing Address - Phone:651-452-7018
Mailing Address - Fax:
Practice Address - Street 1:2020 SILVER BELL RD
Practice Address - Street 2:SUITE 9
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1050
Practice Address - Country:US
Practice Address - Phone:651-452-7018
Practice Address - Fax:651-686-6130
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU76364Medicare UPIN
350001923Medicare ID - Type Unspecified