Individual
DR. JEFFREY JOHN WISDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
7060 VALLEY CREEK PLZ, #121, WOODBURY, MN 55125-2269
(651) 735-8646
(651) 730-9210
Mailing address
7060 VALLEY CREEK PLZ, #121, WOODBURY, MN 55125-2269
(651) 735-8646
(651) 730-9210
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4705
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
724T6WI
BLUE CROSS
MN
Enumeration date
06/12/2006
Last updated
07/08/2007
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