Provider Demographics
NPI:1780770388
Name:PULCZINSKI, JASON DOMINIC (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DOMINIC
Last Name:PULCZINSKI
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 1:13335 PALOMINO DR
Mailing Address - Street 2:STE 101
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4249
Mailing Address - Country:US
Mailing Address - Phone:952-922-3111
Mailing Address - Fax:952-922-0999
Practice Address - Street 1:2460 HIGHWAY 100 S
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1704
Practice Address - Country:US
Practice Address - Phone:952-922-3111
Practice Address - Fax:952-922-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002725Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER