Provider Demographics
NPI:1669526489
Name:NYBLOM, JEFFREY DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DUANE
Last Name:NYBLOM
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 1:911 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-2125
Mailing Address - Country:US
Mailing Address - Phone:763-689-1110
Mailing Address - Fax:763-552-1110
Practice Address - Street 1:911 MAIN ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-2125
Practice Address - Country:US
Practice Address - Phone:763-689-1110
Practice Address - Fax:763-552-1110
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6C486NYOtherBCBS PROVIDER NUMBER
MN6C486NYOtherBCBS PROVIDER NUMBER
MNU69332Medicare UPIN