Provider Demographics
NPI:1700565215
Name:BULFER, JAY RILEY (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:RILEY
Last Name:BULFER
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 1:39621 150TH STREET
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093
Mailing Address - Country:US
Mailing Address - Phone:507-461-5260
Mailing Address - Fax:
Practice Address - Street 1:1800 NORTH STATE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093
Practice Address - Country:US
Practice Address - Phone:507-461-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor