Individual
DR. MICHAEL D JACKLITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
320 DAKOTA AVE, WAHPETON, ND 58075-4515
(701) 642-5600
(701) 642-8354
Mailing address
320 DAKOTA AVE, WAHPETON, ND 58075-4515
(701) 642-5600
(701) 642-8354
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1381
MN
111N00000X
Chiropractor
Primary
351
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013374
—
ND
05
—
141827100
—
MN
01
—
90330JA
BCBS MN
MN
Enumeration date
04/03/2007
Last updated
07/08/2007
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