Provider Demographics
NPI:1700063211
Name:ARNOLD, JONATHAN LEE (DC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LEE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:LEE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5009 EXCELSIOR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3042
Mailing Address - Country:US
Mailing Address - Phone:612-799-7982
Mailing Address - Fax:952-303-4705
Practice Address - Street 1:5009 EXCELSIOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3042
Practice Address - Country:US
Practice Address - Phone:612-799-7982
Practice Address - Fax:952-303-4705
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor