Provider Demographics
NPI:1265738421
Name:JEWELL, DON LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:LEE
Last Name:JEWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:LEE
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11222 86TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4510
Mailing Address - Country:US
Mailing Address - Phone:763-416-1325
Mailing Address - Fax:763-416-1338
Practice Address - Street 1:11222 86TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4510
Practice Address - Country:US
Practice Address - Phone:763-416-1325
Practice Address - Fax:763-416-1338
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5485111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician