Provider Demographics
NPI:1881783314
Name:EIAN, JODIE LEA (DC)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:LEA
Last Name:EIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JODIE
Other - Middle Name:LEA
Other - Last Name:QUINLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:44 SAINT CROIX TRL S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-8404
Mailing Address - Country:US
Mailing Address - Phone:651-436-7757
Mailing Address - Fax:
Practice Address - Street 1:44 SAINT CROIX TRL S
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043-8404
Practice Address - Country:US
Practice Address - Phone:651-436-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38962900OtherBADGERCARE/MEDICAID
MN98D84QUOtherBCBS MN
MNU82674Medicare UPIN